Best paid specialty?

[DrReo]

There have been many posts on this thread and other threads talking about how many GP's are doing more of their own endo work and referring less. This is a conversation I found with the president of AAE and his thoughts on GP's doing more endo.

A little disclaimer...unless I totally just missed the date of this publication I don't not know when this interview happened.( Which could all together void my point.)


GW: What percentage of root canals are being done by GPs as opposed to endodontists?
DR. OLMSTED: We estimate about 70 percent of root canals are being performed by general dentists.

GW: That surprises me.
DR. OLMSTED: Well, it surprised us too. But that estimation is based on numbers we’ve gotten from the dental insurance industry.

GW: Is that a concern for you?
DR. OLMSTED: **No, it’s not a concern. There simply aren’t enough endodontists in the country to handle all the root canals that are needed.** It’s interesting though that most people in the country don’t seem to know what an endodontist does. There are about the same number of endodontists in the United States as dermatologists. Yet most people know what a dermatologist does; but if you ask them what an endodontist does, you often get a blank stare. We’re working on making the public more aware of us, and also trying to educate the public on endodontic treatment.


http://www.dentalcompare.com/featuredarticle.asp?articleid=113

Your thoughts?

Most parents run their child to the dermatologist at first sign of acne to get medications. There's a fair amount of trauma, but a majority of that isn't exported to endo.

---

Members don't see this ad.

 

[TarheelDDS]

I wouldn't trust a single figure on here or what you hear around the dental schools. A lot of the posted salaries on here seem pretty inflated.

I agree with the first part of your statement but not the second part.

My original post was more about things like overhead, patient volume, schedules etc..In other words, potential.

You will hear people making 500k+ a year as ortho, and you will hear people struggling to get by as ortho.

I never trust any salary numbers I hear online.

You can read back through the thread and see that most specialties were represented with someone saying they make the most...

 

[DrReo]

I wouldn't trust a single figure on here or what you hear around the dental schools. A lot of the posted salaries on here seem pretty inflated.

I agree with the first part of your statement but not the second part.

I never trust any salary numbers I hear online.

What type of logic, if any, are you using Tarheel?

 

[2thmaker]

There have been many posts on this thread and other threads talking about how many GP's are doing more of their own endo work and referring less. This is a conversation I found with the president of AAE and his thoughts on GP's doing more endo.

A little disclaimer...unless I totally just missed the date of this publication I don't not know when this interview happened.( Which could all together void my point.)


GW: What percentage of root canals are being done by GPs as opposed to endodontists?
DR. OLMSTED: We estimate about 70 percent of root canals are being performed by general dentists.

GW: That surprises me.
DR. OLMSTED: Well, it surprised us too. But that estimation is based on numbers we’ve gotten from the dental insurance industry.

GW: Is that a concern for you?
DR. OLMSTED: **No, it’s not a concern. There simply aren’t enough endodontists in the country to handle all the root canals that are needed.** It’s interesting though that most people in the country don’t seem to know what an endodontist does. There are about the same number of endodontists in the United States as dermatologists. Yet most people know what a dermatologist does; but if you ask them what an endodontist does, you often get a blank stare. We’re working on making the public more aware of us, and also trying to educate the public on endodontic treatment.


http://www.dentalcompare.com/featuredarticle.asp?articleid=113

Your thoughts?

I really believe that the president of the AAE is downplaying the concern that many AAE members have. While I strongly agree that rotary instrumentation has made endodontics streamlined, the harder truth to accept is that popular rotary manufacturers and their notable reps have given the wrong impression of endodontics. Economics drives all of this (I apologize ahead of time for being a cynic). These reps and notable speakers have fed the GP false information (keeping their revenue elevated during tough economic times), as rotary instrumentation "facilitates" cleaning and shaping; it is not a replacement for adequate and correct endodontic treatment. That is why endodontists are seeing more retreatment and difficult cases with poor outcomes. This feeds into the notion that endodontics as a dental procedure is not successful. This is despite evidence based literature stating that modern endodontic treatment (nonsurgical) has a success rate of almost 95% and retreatment with or without surgery has a success rate around 87%

Other specialities have seen companies and corporations dictate treatment, hiring well known dentist to speak on their behalf. Here in the bay area, it is becoming more and more difficult to find a periodontist who will do perio!! The ones I've met or know second hand have abandoned traditional perio procedures focused on retaining the dentition; it seems that the paradigm has shifted from saving teeth to saving alveolar bone for IMPLANTS. Now periodontists don't do crown lengthening, osseous surgeries, etc.; they would rather do perio plastic procedures such as grafts or place implants. There is more money in implants than other procedures. IT IS THE SIMPLE TRUTH. And with the fees they charge (around 1900 - 2500 for the fixture), they make more. SIMPLE ECONOMICS. GPs place more implants than all specialists combined. The success rates for implants will drop just like the success rates for endo. In the end, reps giving weekend courses are touting the ease of dental procedures; in fact it could be further from the truth. Their goal is to increase their bottom line --- the more dentists use their systems the more they make... and guess what, they won't be around if you get in trouble.

This goes for other specialties that get affected, like OMFS and ortho(especially with ortho marketed to GPs)

It sounds like I'm blaming reps and companies, but let it be known that they are only part of the problem. But I firmly believe that we as dentists ARE the problem but we are also the solution. We know what are capabilities and limitations are. We know how we compare against our fellow GP and specialists. In the end, would you do an implant or a moderately difficult endo or any treatment on your wife/parent/child when you know that your neighborhood specialist does a better job? It's a hard pill to swallow because it directly hits one's pride. How would you want to be treated if you had to be in your spouse's/parents/child and patients' shoes?? If you were your patient, would you give them the option of going to a specialist, or is meeting office overhead more important??

 

[2thmaker]

Oh, and to address the original topic of the poster... the best paid specialty is OMFS (stats from a personal subjective survey). The have the training and flexibility to perform a plethora of procedures, both medical and dental.

I hope the original poster asked this question for statistical purposes and not as ANY deciding factor in choosing a specialty. Do the right thing, treat your patients and staff the way you want to be treated. You will receive more than you will ever need and in the end give away more as a result

cheesy but TRUE!

 

[mike3kgt]

Other specialities have seen companies and corporations dictate treatment, hiring well known dentist to speak on their behalf.

It is true of every part of dentistry. What is classic is when market driven research puts out a product touting the great benefits and is brought to market. 2 years later, the product is rigorously tested in long-term studies and the claims do not always meet the expectations and vice versa.

Now periodontists don't do crown lengthening, osseous surgeries, etc.; they would rather do perio plastic procedures such as grafts or place implants. There is more money in implants than other procedures. IT IS THE SIMPLE TRUTH. And with the fees they charge (around 1900 - 2500 for the fixture), they make more. SIMPLE ECONOMICS.

Have you ever had crown lengthening before? It sucks, plain and simple. I had it done on two of my teeth and thank goodness I had endo on them. The teeth around there were sensitive for 2 years, I now have large embrasures where food gets caught, and if they fail and I need dental implants, I now have less bone there. I made the educated and logical decision at the time, and I decided on saving the teeth. I am glad I did, but our patients can get focused on things like large embrasures and the best fitting crown in the world will fail if the patient is pissed off that every time they eat rice, they need a proxabrush.

There are many potential pitfalls when implants are not placed correctly, but in this age, as a practicing dentist, I would rather do an arch of ceramo-metal FPDs supported by implants rather than full crown lengthening, a perio prosthesis, and continued headaches (caries, attachment loss). Also, we have a sense of legality in this country that is pushing towards definitive treatment for the whole life of the patient (i.e. implants versus perio prostheses).

Now there is a time and place for crown lengthening and traditional perio. The periodontists are still doing it, just not as often as before. Procedures like root amp and hemisections are practically gone by the wayside, but traditional osseous surgery will be around a while longer, but may also disappear in our lifetime.

 

[Stroszeck]

at my dental school we have a crappy endo program that does like 2 surgeries a year and we also have a very aggressive perio program which crown lengthens every other tooth. the fact is that a lot of these surgical procedures are less common because why work so hard on a tooth with a less than stellar prognosis when a decent single unit implant will suffice and you don't have to worry about secondary caries etc? Plus in california, esp southern its become kind of like a point of bragging between patients to get implants

 

[DudeDDS]

The best paying specialty is the one you can get into !

If you can't get into one, then the answer is none.

 

[tncekm]

I personally know a prosthodontist making $30k/day at his practice, not including about $2k/day in hygiene. He, I swear to God, only has 2 employees (hygiene and front desk / assistant) if you don't include his in-house lab.

I'm not sure what his take-home is (percentage), but I know his I'm surprised his wife can lift the diamond on her hand without the assistance of hydraulic equipment.

 

[anishannayya]

I personally know a prosthodontist making $30k/day at his practice, not including about $2k/day in hygiene. He, I swear to God, only has 2 employees (hygiene and front desk / assistant) if you don't include his in-house lab.

I'm not sure what his take-home is (percentage), but I know his I'm surprised his wife can lift the diamond on her hand without the assistance of hydraulic equipment.

I'm gonna go ahead and call BS on that before anyone else does. My mental math isn't great, but you do realize that 32K a day is ~ 12 mill a year, right?

 

[ChubbyBaby]

I personally know a prosthodontist making $30k/day at his practice...

unpossible

 

[tncekm]

I'm gonna go ahead and call BS on that before anyone else does. My mental math isn't great, but you do realize that 32K a day is ~ 12 mill a year, right?

Go ahead, believe what you want. At 5 days/wk, it's about $8 mln. For "me" this is not a "word of mouth" thing, this is an "OMG, I can't believe there is that much money in production on the computer screen" thing. So, on my end at least, I know I'm not just disseminating baloney hear-say.

 

[tncekm]

unpossible

LOL. Believe what you will. Why the hell do I care what some dentist is making, and why would I care to come into the dental forum and brag about it? I'm not going into dental, I don't get any of that dude's money, and I've got much less ridiculous stuff to do than go make up lies in the dental forum.

Seeing is believing; I see, I believe. You don't see, you don't. Such is life.

Oh, and as an aside, I also know a GP who was making around $10k/day give or take about $5k on any given day. Sometimes he would pull in $10-15k of work by mid-day and go home. Is that more believable? LOL

 

[ChubbyBaby]

For "me" this is not a "word of mouth" thing, this is an "OMG, I can't believe there is that much money in production on the computer screen" thing.

Was the computer displaying average production/day over a long period of time?

I mean, I'd believe the occasional $30k per day thing happening in some prosth practices. After all, these full-mouth rehab cases can be over $80k. So depends when they're billed out, or if they're payed in installments. Generally, these full-mouth rehab cases take multiple-multiple-multiple visits so a production report can be a little misleading if not viewed over a long period of time.

 

[ChubbyBaby]

The most productive dental procedure is endo, hands down.

 

[tncekm]

I didn't see a super long trend. So, you're right... it's possible it was just an extraordinarily good period of time. But heck, hypothetically, even if we knock off $15k off of that average, it doesn't change the fact that prosthodontics can be extremely lucrative. And, I was told by the front office lady, without specifics, that its multi-millions/yr. On a side note, his practice is super busy, expanding, in a notoriously wealthy part of America and he does tons of cash patients.

 

[Oracle DMD]

The most productive dental procedure is endo, hands down.

more than a crown? how much are you charging for endo and are you doing in less than an hour?

 

[OceanDMD]

The most productive dental procedure is endo, hands down.

Unless it takes you 2 - 3 appointments and your working on PPO based fees.
Otherwise, I agree. Proficiency with molar endo is a practice builder.

 

[OceanDMD]

more than a crown? how much are you charging for endo and are you doing in less than an hour?

Average fee for a crown, $1000. Take out a lab bill of 1-200 dollars. 2 appointments, I schedule 50 minutes for my prep and temp, 30 minutes to insert.

Endo: single canal 30 -40 minute appointment.
Molar 60 -80 minutes. Molar fee is 1k. Premolar and Anterior fee 700.
You can see how the hourly production works out. Important thing is setting your fees right.

And my non molar endo fees are too low.

 

[Demeter]

I like using Pros as an example since it's the restorative specialty and closest relative of traditional general dentistry. Two words of wisdom:

1) You don't know what you don't know. Until you learn it in residency.

2) Assuming you spend 60 hours a week x 50 weeks a year x 3 years in Pros residency, you're committing yourself to 9000 hours of "CE" as it were in concentrated prosthodontic training.

If you "believe" in the value of education and wide knowledge base, there's no substitute for residency training. Same holds true for the other specialties. Should a GP with CE training attempt a BSSO? Probably not. And I'd argue that the reason (besides licensing) is that the bar is raised. The risks are higher. What's the worst that can happen to a GP attempting a 16-unit FPD... The patient's jaw starts to hurt? Sure, an OS could botch a surgery just like a Pros could botch a FMR -- but the additional training is there to both help prevent problems and to better manage them if and when they come along. And for that reason, I believe that any education to the level of residency training is invaluable. Now, whether it makes financial sense for the dentist is an entirely different question.

The problem with pros is that many GP's will only refer the worst cases. Many GPs with some experience will say Hey I can do a 16 unit case. Thats a ton of money to refer out. OMFS, difficult Endo or Pedo will usually be out of the comfort zone of these guys.

 

[armorshell]

The most productive dental procedure is endo, hands down.

I think you're forgetting about the treasure chests located slightly distal to the 2nd molar.

 

[ChubbyBaby]

I think you're forgetting about the treasure chests located slightly distal to the 2nd molar.

Dollars per hour yes extracting wisdom teeth is probably more profitable than endo.

BUT, do oral surgeons spend their whole day extracting wisdom teeth? How profitable are: biopsies, TMJ stuff, orthagnathic surgery, and trauma?

Of course, if you're a mildly competent dentist you'll be making more than enough money to be happy.

 

[lotexigeus]

Dollars per hour yes extracting wisdom teeth is probably more profitable than endo.

BUT, do oral surgeons spend their whole day extracting wisdom teeth? How profitable are: biopsies, TMJ stuff, orthagnathic surgery, and trauma?

Of course, if you're a mildly competent dentist you'll be making more than enough money to be happy.

most of it

 

[ChubbyBaby]

most of it

do you have a relative that's an oral surgeon. YOur status says dental student. ?

 

[ziptree]

The most productive dental procedure is endo, hands down.

I think you're forgetting about the treasure chests located slightly distal to the 2nd molar.

Dollars per hour yes extracting wisdom teeth is probably more profitable than endo.

BUT, do oral surgeons spend their whole day extracting wisdom teeth? How profitable are: biopsies, TMJ stuff, orthagnathic surgery, and trauma?

Of course, if you're a mildly competent dentist you'll be making more than enough money to be happy.

Most profitable?

1) Extractions of #1 and #16. #17 and #32 if you can get the patient sedated or you have no qualms about troughing buccally and rolling the tooth out. A dentist can pop out #1 and #16 in less than 15 minutes from start to finish total.

2) Endodontics. Very little overhead. Place the core during the same appointment and it's an extra $200 for a 3-minute core placement.

3) Fillings.

4) Bridges. You bill out for more units than you have to prep.

5) Crowns. I use CEREC and will couple my crown appointments at the same time as fillings in the same quadrant/side. While the restoration is milling (~15 minutes on average), you can prep at least 2-3 teeth (MO/DO/MOD) or do 4-5 occlusal fillings.

Efficiency is key.

 

[lotexigeus]

do you have a relative that's an oral surgeon. YOur status says dental student. ?

back in my undergrad days i shadowed an oral surgeon for a week. Almost all procedures were thirds. Got kinda boring after a while.

 

[prestone346]

I think you're forgetting about the treasure chests located slightly distal to the 2nd molar.

Haha

 

[libratl]

I think you're forgetting about the treasure chests located slightly distal to the 2nd molar.

And implants for OS?

 

[mike3kgt]

Was the computer displaying average production/day over a long period of time?

I mean, I'd believe the occasional $30k per day thing happening in some prosth practices. After all, these full-mouth rehab cases can be over $80k. So depends when they're billed out, or if they're payed in installments. Generally, these full-mouth rehab cases take multiple-multiple-multiple visits so a production report can be a little misleading if not viewed over a long period of time.

Exactly right. I actually worked in a prostho practice as a GP for 2 years and average monthly production is over $100k on average. There is no way possible to actually produce $30k a day, every day of practice. Producing $30k means that you are seating a full mouth of crowns or implants once a day and also prepping a full arch and impressioning to keep up the flow. It could also be possible to practice in such an affluent area that your denture fee is $8-10k and you are delivering 3-5 dentures a day and starting 3-5 dentures a day.

Not saying it couldn't happen, but your understanding of dental producing is a little dubious.

Now, I would say, however, that on average, a prosthodontist can produce between $5-15k a day on average if there is a good mix of procedures.

By far my most profitable procedure in practice was extractions & removable. $300 each tooth and $2500 each arch definitely adds up. Then again, I'd rather reach for a 151 instead of a k-file any day.

 

[OceanDMD]

Exactly right. I actually worked in a prostho practice as a GP for 2 years and average monthly production is over $100k on average. There is no way possible to actually produce $30k a day, every day of practice. Producing $30k means that you are seating a full mouth of crowns or implants once a day and also prepping a full arch and impressioning to keep up the flow. It could also be possible to practice in such an affluent area that your denture fee is $8-10k and you are delivering 3-5 dentures a day and starting 3-5 dentures a day.

Not saying it couldn't happen, but your understanding of dental producing is a little dubious.

Now, I would say, however, that on average, a prosthodontist can produce between $5-15k a day on average if there is a good mix of procedures.

By far my most profitable procedure in practice was extractions & removable. $300 each tooth and $2500 each arch definitely adds up. Then again, I'd rather reach for a 151 instead of a k-file any day.

You need to challenge yourself. Nothing like looking for that MB #2.......

 

[furcation]

Its funny how much this is debated. It definitely depends on the dentist, and there business skills. it can vary so much. But..... straight from the ADA survey 2005. but these are averages, we all know GPs making close to 500,000. but its rare.

GP: 215,000 (2007,m rest are 05)
OS: 390,000
Pedo: 314,000
Endo: 327,000
Perio: 263,000
Ortho: 285,000
Prosth: 212,000

 

[Slack3r]

Its funny how much this is debated. It definitely depends on the dentist, and there business skills. it can vary so much. But..... straight from the ADA survey 2005. but these are averages, we all know GPs making close to 500,000. but its rare.

GP: 215,000 (2007,m rest are 05)
OS: 390,000
Pedo: 314,000
Endo: 327,000
Perio: 263,000
Ortho: 285,000
Prosth: 212,000

Why does pedo pay so well? In medicine, ped specialties are usually reimbursed lower than their adult counterparts.

 

[NewNameForGoogleBot]

Why does pedo pay so well? In medicine, ped specialties are usually reimbursed lower than their adult counterparts.

Volume

 

[ChubbyBaby]

Its funny how much this is debated. It definitely depends on the dentist, and there business skills. it can vary so much. But..... straight from the ADA survey 2005. but these are averages, we all know GPs making close to 500,000. but its rare.

GP: 215,000 (2007,m rest are 05)
OS: 390,000
Pedo: 314,000
Endo: 327,000
Perio: 263,000
Ortho: 285,000
Prosth: 212,000

Prosth makes less than GP?!

 

[ChubbyBaby]

ortho is such an over-rated specialty.

i'd rather be a gp than an orthodontist.

 

[dentaldawg32]

ortho is such an over-rated specialty.

i'd rather be a gp than an orthodontist.

 

[Slack3r]

Volume

Because kids will typically have less complications? I don't understand why you could bust out kids real fast but adults slow you down.

Not to be insulting, just curious.

 

[armorshell]

Prosth makes less than GP?!

The GP numbers are 2007 (And those numbers don't include associates IIRC), the prosth numbers are from 2005, and do include associates.

There's a study out there which determined the financial IRR of prosth over GP, and assuming you practice full time, and had a stipend for your prosth residency, the IRR is about 12% over GP.

Private Practice and the Economic Rate of Return for Residency Training as a Prosthodontist
Nash, Kent D. [1], Pfeifer, David L. [2]
Jada 2005; 136:1154-1162.

 

[Dukie]

Because kids will typically have less complications? I don't understand why you could bust out kids real fast but adults slow you down.

Not to be insulting, just curious.

In a pedo practice, the assistants can typically do the prophy. All you have to do is a quick "well baby" check up, which only takes a minute or two. There are also a lot of CCRR's and other simple operative procedures which take no time and pay well. As someone else said, pedo is all about volume. You have to get good and working fast and being comfortable seeing 40-50 patients in a day to make good money. It's a great field if you are up for that type of lifestyle.

 

[OceanDMD]

In a pedo practice, the assistants can typically do the prophy. All you have to do is a quick "well baby" check up, which only takes a minute or two. There are also a lot of CCRR's and other simple operative procedures which take no time and pay well. As someone else said, pedo is all about volume. You have to get good and working fast and being comfortable seeing 40-50 patients in a day to make good money. It's a great field if you are up for that type of lifestyle.

In many states, this is illegal. Assistants may not polish enamel.

 

[Regmata]

Maybe he meant hygienists...

 

[charlestweed]

You can do coronal polishing with the RDA license in California. My assistants do this everyday...polish the teeth before placing the ortho brackets.

 

[ChubbyBaby]

Because kids will typically have less complications? I don't understand why you could bust out kids real fast but adults slow you down.

Not to be insulting, just curious.

pedos can do total crap work on teeth; doesn't matter cause those teeth will exfoliate in a few anyhow.

 

[korndoctor]

why are proths paid so less compared to other specialties? is it because it takes time to make a denture or is it because of some other factor?

endo is 2 year residency while prosth is 3 year, doesnt make sense. someone please elaborate

 

[mike3kgt]

why are proths paid so less compared to other specialties? is it because it takes time to make a denture or is it because of some other factor?

endo is 2 year residency while prosth is 3 year, doesnt make sense. someone please elaborate

Keep thinking that this is true to justify doing RCTs all day long. I worked in a prostho practice where the guy was taking home far more than many endodontists.

This has to do on the fact that you absolutely should not do prostho if you are only about the $$. Stick with endo or ortho if that's the case. You don't need a personality to do oral surgery or endo like you need in prosthodontics. You could be a total butthole and still have patients all over the place in oral surgery.

In prosthodontics (or any high end GP practice), patients are paying extra $$ for YOU and your quality of treatment and follow up. The patients value the relationship and are willing to pay for it. If you truly love prosthetic dentistry and work hard at it, your income will far exceed your expectations.

 

[Jazzinax]

awesome!

 

[robpardee]

I've heard from several of my profs that pros specialists are one of the highest paid per hour in the country of all professions.

 

[og2]

I've heard from several of my profs that pros specialists are one of the highest paid per hour in the country of all professions.

what kinda professors are these? specialists? GPs? prosthodontists?

 

[Stroszeck]

I've been told the same thing about prosth time and time again. Most people do not want to go into it because of the difficult 3 year residency (although all specialty residencies are tough), but the monetary rewards with pros seem to be amazing, IN SPITE of lab fees prosths make an absolute killing. But again if all you care about is money and status then stick with OMFS.

 

[Rezdawg]

The highest money maker would be a GP that has some business skill.

Of all the dentists I know (OMFS, Endo, Pedo, Perio)...none come close to the earnings that 2 GP friends make.

Now, if we are talking strictly dental procedures, then I'd probably go with pedo as the answer...they have much more hectic schedules (up to 40 patients a day), but by the end of the week, they'll be sitting pretty.