Best paid specialty?

[eventualOMFS]

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.

As ChubbyBaby and Mike said, the $30k day isn't abnormal in pros upon completion of full-mouth rehabs. I don't doubt that he's doing really well, but he isn't averaging that every day.

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.

Gotta disagree with Chubby here - $/hr extracting 3rds is WAY more profitable then endo. And OS do spend most of their days shucking 3rds, at least in private practice (assisted for 4 yrs) - add implants, and OS definitely has the highest earning potential.

Many surgeons do perform orthognathic surgeries, trauma cases, and take call in the hospital - and yes, it pays poorly relative to 3rd/implants. But many surgeons limit hospital days to 1-4 days per month - really doesn't take up that much time. Some mess around with TMJ surgeries, many don't.

That said, OMFS spend more time in training than any other dental profession - so the higher potential doesn't come without a cost.

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.

I think these studies are the best way to evaluate how specializing affects income. A 2001 by Cordes adjusted for hours worked and calculated IRR for ortho=16.62% and IRR for OMFS=26.83%. Downside is that these studies often use small sample sizes, and they are only done every several years.

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.

This is wrong on both counts.
1. You can't say that GP with business skills > all specialists. Rather, you should be comparing GP with business skills to a specialist with similar business skills - and the specialist will have a higher earning potential. Of course, the highest-earning GP will earn more than the lowest-earning OMFS...but you need to look at averages, or at least similar groups (like top 5% GPs vs top 5% OMFS).
It should also be said that everybody thinks they're going to be the Donald Trump of dentistry...trust me, I too get caught up in all that ("I read SDN and DentalTown, I'll be golden"). But having true business acumen is a lot tougher than it seems - I'm trying to prepare myself for that harsh reality.

2. Experiential data with a sample size of 2 is NOT a proper way to judge the earning potential of members of a profession.

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[yappy]

Do these IRR % adjust for taxes? It seems like once you get into the income brackets that a DDS/DMD are in - regardless of speciality - there are significant dimishing returns to an increase in pay. Therefore, the realized % increase maybe much less than these studies suggested?

 

[8 SNAKE]

1. You can't say that GP with business skills > all specialists. Rather, you should be comparing GP with business skills to a specialist with similar business skills - and the specialist will have a higher earning potential.

This whole thread is pretty silly, but I don't agree with your logic here. Any GP or specialist with good business skills who wants to rake in cash is going to build a scalable practice and isn't going to be impacted as much by the revenue that he/she can produce. If you're focusing on individual production, you've probably already lost this game.

 

[mike3kgt]

This whole thread is pretty silly, but I don't agree with your logic here. Any GP or specialist with good business skills who wants to rake in cash is going to build a scalable practice and isn't going to be impacted as much by the revenue that he/she can produce. If you're focusing on individual production, you've probably already lost this game.

+1

Let this thread die already, please!

 

[Rezdawg]

This is wrong on both counts.
1. You can't say that GP with business skills > all specialists. Rather, you should be comparing GP with business skills to a specialist with similar business skills - and the specialist will have a higher earning potential. Of course, the highest-earning GP will earn more than the lowest-earning OMFS...but you need to look at averages, or at least similar groups (like top 5% GPs vs top 5% OMFS).
It should also be said that everybody thinks they're going to be the Donald Trump of dentistry...trust me, I too get caught up in all that ("I read SDN and DentalTown, I'll be golden"). But having true business acumen is a lot tougher than it seems - I'm trying to prepare myself for that harsh reality.

2. Experiential data with a sample size of 2 is NOT a proper way to judge the earning potential of members of a profession.

How many specialists get heavily involved in the business side of dentistry? Do you realize how low that number is? What would be the point of going to school for an extra 6 years if you're just going to come out and start getting into the business side of things? The fact of the matter is that there are almost no oral surgeons that push the business side of things as hard as some GPs do...and if they do, then the incomes won't be very different, I can assure you of that.

I'm also not using a sample size of 2 to judge members of a profession...I'm using a sample size of over 100 dentists in all specialties and fields...and the top 2 earning dentists that I know are general practitioners, and it's not even remotely close.

 

[fishyfishy]

How many specialists get heavily involved in the business side of dentistry? Do you realize how low that number is?

What does "heavily involved in the business side" mean exactly? Every OMFS I know personally runs their own small business, so they are pretty freaking heavily involved in their private business.

The fact of the matter is that there are almost no oral surgeons that push the business side of things as hard as some GPs do...and if they do, then the incomes won't be very different, I can assure you of that.

This is seriously the most generalized hearsay statement I have ever heard on this website for scientific professionals.

I'm also not using a sample size of 2 to judge members of a profession...I'm using a sample size of over 100 dentists in all specialties and fields...and the top 2 earning dentists that I know are general practitioners, and it's not even remotely close.

I don't think those top 2 dentists do so well because they are GP. Rather, they have a good business sense, thus are doing well. The top 2 plumbers in my hometown make over 1 million dollars/yr running plumbing companies, does that mean plumbing is a more lucrative career than specialist dentists? Probably not.

I think you are generalizing a bit too much, while not taking into account the natural confounding factors that occur when trying to define a widely varying career like our own.

 

[Rezdawg]

What does "heavily involved in the business side" mean exactly? Every OMFS I know personally runs their own small business, so they are pretty freaking heavily involved in their private business.

Every practice owner runs a small business...thats not the point. However, the GPs that are more heavily involved in business not only have their own offices, but they also own a good number of other clinics. I have a dentist friend that owns 27 practices. The dentist I work for has 8 clinics. There are many cases like this. All of my specialist friends and family, they have their own, very lucrative practices...but they dont go around purchasing and buying other practices. That doesnt make as much sense for a specialist. Again, why go through 6 years of oral surgery residency, if you plan on being more of a business man than a dentist? You just dont see many specialists pursue the hardcore business side of dentistry like you see with GPs. And thats a fact. Think about it...is an oral surgeon going to open up multiple oral surgery clinics? Of course not...that would be incredibly difficult to pull off, considering the fact that it would be almost impossible to fill these offices up with oral surgeons. Of course, an oral surgeon can open up a dental office for some extra income on the side...but then they would be on par with a GP opening up a dental office for some extra income on the side. Thats why I said that if they both get involved heavily on the business side of things, you wont see much of a difference in incomes.

This is seriously the most generalized hearsay statement I have ever heard on this website for scientific professionals.

Read above.

I don't think those top 2 dentists do so well because they are GP. Rather, they have a good business sense, thus are doing well. The top 2 plumbers in my hometown make over 1 million dollars/yr running plumbing companies, does that mean plumbing is a more lucrative career than specialist dentists? Probably not.

You are comparing plumbing to dentistry (apples to oranges). Im comparing dentistry to dentistry (apples to apples).

 

[fishyfishy]

You are comparing plumbing to dentistry (apples to oranges). Im comparing dentistry to dentistry (apples to apples).

I think the basis of your comparison is that GP's have potentials to make more money than specialists. IMO, this is actually comparing apples to orange, because successful GPs are businessmen, not dentists. Meanwhile, successful specialists tend to be dental professionals, basing income off of manual production.

Anyways, if we want to generalize, I think the easiest way to do that is to say that specialists make more money than GPs with less effort (looking at IRR% and avg salaries). However, if a dental professional has an extraordinary business acumen they have the potential to make more and trump anybody else, specialist or GP... In this case, comparing them to a plumbing company CEO will be the same, as both are essentially businessmen, not tradesmen.

 

[Mackchops]

How's this? My dad always said, "do what you love and you'll never work a day in your life". If you go into something like pros or OS for the money and you don't love it, you'll be miserable and it will show in your work. You'll have a much harder time becoming financially successful compared to the GP who loves being a GP and is good at it.

In the end, if you're going into dentistry for the big bucks, I highly advise you to seek out one of the careers that doesn't require so much school, training, and headaches. There are much easier and quicker ways to become rich than by being a dentist -- of any sort.

 

[Rezdawg]

I think the basis of your comparison is that GP's have potentials to make more money than specialists. IMO, this is actually comparing apples to orange, because successful GPs are businessmen, not dentists. Meanwhile, successful specialists tend to be dental professionals, basing income off of manual production.

Im not saying GPs have more potential...Im saying that you will see GPs push the business envelope more than specialists...thus the reason why the many of the most financially successful dentists tend to be GPs, because you wont see many of the specialized dentists acting as businessmen.

I havent said anything that should be remotely shocking to anyone that is familiar with the profession...not sure why you responded to my original post in the first place as it says nothing noteworthy or new.

 

[fishyfishy]

Im not saying GPs have more potential...Im saying that you will see GPs push the business envelope more than specialists...thus the reason why the many of the most financially successful dentists tend to be GPs, because you wont see many of the specialized dentists acting as businessmen.

I havent said anything that should be remotely shocking to anyone that is familiar with the profession...not sure why you responded to my original post in the first place as it says nothing noteworthy or new.

I guess oversimplified and unfounded statements like "Im saying that you will see GPs push the business envelope more than specialists" makes the scientist in me desire more empirical backing. Can you give me the statistics for this? No, because you are simply telling me that you are familiar with the profession, and that is your point of view.

You talk about familiarity with the profession, but it is constantly changing every single decade. In fact, it changes with every single state, and region within a state! You can't make a blanket statement that covers ~150,000 practicing dentists using a pool of 100 dentists that you "know," then post this as a fact.

This thread was about the best paid specialty. I'm not sure why it diverged into the discussion of GP vs. specialty anyways, unless it was to make a point that GPs as better paid than specialists (which is simply not true on avg. according to ADA salaries).

I think we're about done here.

 

[Rezdawg]

I guess oversimplified and unfounded statements like "Im saying that you will see GPs push the business envelope more than specialists" makes the scientist in me desire more empirical backing. Can you give me the statistics for this? No, because you are simply telling me that you are familiar with the profession, and that is your point of view.

You talk about familiarity with the profession, but it is constantly changing every single decade. In fact, it changes with every single state, and region within a state! You can't make a blanket statement that covers ~150,000 practicing dentists using a pool of 100 dentists that you "know," then post this as a fact.

This thread was about the best paid specialty. I'm not sure why it diverged into the discussion of GP vs. specialty anyways, unless it was to make a point that GPs as better paid than specialists (which is simply not true on avg. according to ADA salaries).

I think we're about done here.

Its called simple logic mixed with real life data...and I didnt think I had to back it up with scientific data, given that there really is no debate to the comment that GPs generally push the business side of dentistry more than specialists.

And this thread is obviously about money...and if you are really in it for the money, then going to school for a handful of years after dental school is probably not the smartest route. If you want to make money in this profession, then you better be business savvy and then choose to take that route once you get your degree...since the dental part of the profession is obviously not the most important, given that money is the driving force behind the equation.

And to cap it off, Ive never said that GPs are better paid than specialists, so if you want to put words in my mouth, then read my statements more carefully next time.

 

[UltimateHombre]

How many specialists get heavily involved in the business side of dentistry? Do you realize how low that number is? What would be the point of going to school for an extra 6 years if you're just going to come out and start getting into the business side of things? The fact of the matter is that there are almost no oral surgeons that push the business side of things as hard as some GPs do...and if they do, then the incomes won't be very different, I can assure you of that.

I'm also not using a sample size of 2 to judge members of a profession...I'm using a sample size of over 100 dentists in all specialties and fields...and the top 2 earning dentists that I know are general practitioners, and it's not even remotely close.

This is a very hard thing to measure, because of the drastic ratio of GPs/Specialits. Obivously you are going to see more business minded GPs, just because there is many more of them then Specialits.

Having said that, I know several specialists that own serval practices/clinics, just as a GP would, which enables them to make tons of money. For example, a pedo i shadowed owned 8 practices and employed 6-7 associates. I also shadowed a OS who owned a clinic and employed 5-6 OS at any given time. If you compare financial earnings with a GP of similar stats/assets, the specialits will win every time.

Furthermore, I think that specialists have more liquid cash right out of school to grow their practice or invest how they choose. I know many specialits who own other businesses or have bought into investment LLCs early in their career, and now their practice revenue is the least of all their assets.

Now i am a pre-dent, so what do i know, but there is my experience and 2 cents. Cheers!!

 

[charlestweed]

Having said that, I know several specialists that own serval practices/clinics, just as a GP would, which enables them to make tons of money. For example, a pedo i shadowed owned 8 practices and employed 6-7 associates. I also shadowed a OS who owned a clinic and employed 5-6 OS at any given time. If you compare financial earnings with a GP of similar stats/assets, the specialits will win every time.

Really? I know a lot of specialists since I went to a school (UCLA) that has a high number of students who specialize. I don't see a lot of the above senarios where the specialist has to hire associate specialists to help handle the high patient load. Instead, I see a lot of specialists (ortho, perio, os, endo) who don't have enough patients and have to travel to different offices in order to stay busy. I (an orthodontist) have to set up 3 different offices in order to stay busy.

Furthermore, I think that specialists have more liquid cash right out of school to grow their practice or invest how they choose. I know many specialits who own other businesses or have bought into investment LLCs early in their career, and now their practice revenue is the least of all their assets.

It is true that specialists have more liquid cash right out of school and therefore, it is easier for them to start an office. Why? Because the specialists make more per day than the GPs. For example, when an OS travels to a GP office to perform wisdom teeth extractions, this GP office usually saves 4-5 extraction cases for this OS…and this OS can easily bring home $2-3k for that day. By traveling to 4-5 different GP (or other multispecialty)offices, the OS should save enough $$$ to start his/her own private office. And while his/her new practice grows, the OS continues to travel to other offices to earn additional income. The same applies to perio, ortho, endo.

 

[Rezdawg]

Really? I know a lot of specialists since I went to a school (UCLA) that has a high number of students who specialize. I don't see a lot of the above senarios where the specialist has to hire associate specialists to help handle the high patient load. Instead, I see a lot of specialists (ortho, perio, os, endo) who don't have enough patients and have to travel to different offices in order to stay busy. I (an orthodontist) have to set up 3 different offices in order to stay busy.

This is exactly what I see. There is no doubt that specialists make a crap load of money, regardless of their field or their job position, whether its owning their own clinic or rotating through GP offices. Regardless, there will be demand in some way. I havent come across many specialists that have multiple clinics, while employing multiple specialists (i.e. an oral surgeon having a clinic where he has 3 oral surgeons working for him...there just isnt enough demand for that to happen often enough).

It is true that specialists have more liquid cash right out of school and therefore, it is easier for them to start an office. Why? Because the specialists make more per day than the GPs. For example, when an OS travels to a GP office to perform wisdom teeth extractions, this GP office usually saves 4-5 extraction cases for this OS…and this OS can easily bring home $2-3k for that day. By traveling to 4-5 different GP (or other multispecialty)offices, the OS should save enough $$$ to start his/her own private office. And while his/her new practice grows, the OS continues to travel to other offices to earn additional income. The same applies to perio, ortho, endo.

At the office I am at right now, we save wisdom teeth and surgical extractions for an OS. We schedule him 1 day, every 3 or 4 weeks, and he comes and knocks out about 6 patients that day...walks away with what I make for that entire week.

If he works 2 days a week like that then he doesnt really need to worry about getting heavily involved in the business side of things...why go through the stress and work of business crap when you are already making big bucks? Thats why you dont see many specialists push the envelope, because they are already well off...you see GPs go hard after the business side, because, well, they are trying to figure out a way to become well off...like most of the specialists out there. But, the ones that do rock on the business side, they are basically striking gold and end up doing quite well for themselves.

 

[yappy]

Hey Rezdawg,

Thanks for sharing your experience. One thing that I had a question about though is that when I viewed the average income of gp and other specialists located on this post; it didnt seem that the after taxes / mal practice would be worth foregoing income for 3-6 yrs in order to specialize if money was your only concern. Do you agree with this or do you believe the average incomes were off?

 

[KinKs]

Hey Rezdawg,

Thanks for sharing your experience. One thing that I had a question about though is that when I viewed the average income of gp and other specialists located on this post; it didnt seem that the after taxes / mal practice would be worth foregoing income for 3-6 yrs in order to specialize if money was your only concern. Do you agree with this or do you believe the average incomes were off?

After all the BS that Rezdawg typed I can't believe that anyone wishes to hear his opinion. Lets see what more he knows through his connections. I bet he would be one of those name dropping MoFos that I cant stand LMAOL - and if anyone wants to hurl an insult, dont bother, I probably not going to check - I have Anesthesiology and Restorative Midterms on Monday.

 

[Rezdawg]

Hey Rezdawg,

Thanks for sharing your experience. One thing that I had a question about though is that when I viewed the average income of gp and other specialists located on this post; it didnt seem that the after taxes / mal practice would be worth foregoing income for 3-6 yrs in order to specialize if money was your only concern. Do you agree with this or do you believe the average incomes were off?

No, if you are able to specialize, you'll definitely be better off financially if you decide on that route. There is no debate in that...even though the opportunity cost is high while you are specializing, you'll make up for it rather quickly.

However, my advice would be to not specialize unless you have a genuine interest in a certain field. If you do find something that interests you and you do want to make great guaranteed money, then specialize.

A GP can make a good living off dentistry...A GP can make great money with good business sense and a drive to pursue that option. However, at the end of the day, business always has an associated risk. Therefore, the safer route to financial freedom is specializing.

 

[Rezdawg]

After all the BS that Rezdawg typed I can't believe that anyone wishes to hear his opinion. Lets see what more he knows through his connections. I bet he would be one of those name dropping MoFos that I cant stand LMAOL - and if anyone wants to hurl an insult, dont bother, I probably not going to check - I have Anesthesiology and Restorative Midterms on Monday.

lol, what have I said that is BS?

Go back to being a dental student, while Im actually living and working in the real world.

 

[DrReo]

No, if you are able to specialize, you'll definitely be better off financially if you decide on that route. There is no debate in that...even though the opportunity cost is high while you are specializing, you'll make up for it rather quickly.

However, my advice would be to not specialize unless you have a genuine interest in a certain field. If you do find something that interests you and you do want to make great guaranteed money, then specialize.

A GP can make a good living off dentistry...A GP can make great money with good business sense and a drive to pursue that option. However, at the end of the day, business always has an associated risk. Therefore, the safer route to financial freedom is specializing.

Do you believe this is true for periodontics? Including the fact that it's a 3 yr residency and sometimes includes tuition costs of 20-45k/yr (+ housing).

What are you making your first year out?

 

[Rezdawg]

Do you believe this is true for periodontics? Including the fact that it's a 3 yr residency and sometimes includes tuition costs of 20-45k/yr (+ housing).

What are you making your first year out?

Yeah, I'd definitely say it holds true for perio too. At least, the periodontists in my area that I am involved with. I know that they had some rough beginnings when they opened up their offices, but now theyre so busy that its almost too much for them to handle. Implants are the big thing these days...so the specialties that place them are doing quite well. I know a few GPs that refer their implant cases strictly to periodontists, so thats good for them.

It really all depends on location, how well the periodontists get their names out there to the GPs, how they market themselves, etc...

I wouldnt let the tuition over the few years be a deterrence.

I have a couple jobs...work 5 days a week. Depends on the month, there seem to be a lot of up and downs. Summer months is crazy with kids, last month was pretty slow, etc... First year out, approx income about 180K.

 

[eventualOMFS]

Really? I know a lot of specialists since I went to a school (UCLA) that has a high number of students who specialize. I don't see a lot of the above senarios where the specialist has to hire associate specialists to help handle the high patient load. Instead, I see a lot of specialists (ortho, perio, os, endo) who don’t have enough patients and have to travel to different offices in order to stay busy. I (an orthodontist) have to set up 3 different offices in order to stay busy.

This is highly dependent upon location. Are you still in CA?

 

[charlestweed]

This is highly dependent upon location. Are you still in CA?

Yes, I still am. From talking to a few struggling orthodontists in other states (from this SDN forum and Orthotown forum), I think it is better for me to stay here in CA. Don’t assume that when you move away from saturated markets (in CA), you will do better…this is true for GPs but not true for specialists.

Keep in mind that the specialists (especially OS, endo, perio) get new patients from the GPs….not from walk-in, not from the yellow pages, not from word of mouth. A specialist who has higher number of referring GPs is more successful than a specialist who has fewer referring GPs. Practicing in big cities has allowed me to meet more referring GPs; there are GP offices in every corner. If I piss one referring GP off, I still have a lot of other GPs to get the new patients from. Higher number of GPs in big cities also gives the specialists more places to work as in-house specialists. There are fewer GPs in rural areas; therefore, it is harder for specialists to do well in these areas.

A specialist must also maintain good communication with both the GPs and the patients they refer to. It is harder for the referring GPs to communicate with a specialist when this specialist has 2-3 other associate specialists working for him/her. Most associate specialists care more about $$$ than about their owner’s practice. Poor communication usually leads to loss of GP referral.

 

[Stroszeck]

The bottom line with a thread like this is that unforunately like most of the other threads on SDN, its just pure speculation on the part of pre-dents! People on here talk about how "lucrative" endo is and how you could specialize in endo and do "10 root canals a day" at $1100 a pop and have 20% overhead blah blah. What they fail to do is mention that those 30 minute root canals done by supergeneralists most often have missed canals, poor obturation etc and that as an endodontist you are on average doing only 3 or 4 root canals, paying MUCH MORE than 20 or 30% overhead (yes those rotary files etc are in fact very expensive) and you are forced to do difficult cases which take minimum 1 to 2 hours to do and may include multiple visits. I'm just using endo as an example. So to say something is lucrative is simply just an assumption based on dental students thinking that an endodontist treats the type of cases they treat in undergrad clinics - mostly straight canals, nice large pulps, no calcifications whatsoever. yes if that was endo then all endodontists would be multi-mililionaires. Same with perio...its not just performing a simple S&RP or "prophy." Those guys EARN their dollars and have to deal with a lot of disgusting difficult cases. Same thing with pedo - you will see TONS of children and will often see autistic and special needs children, as well as children with emotional and behavioral problems. My advice? SHADOW SHADOW SHADOW. Don't stop when you get to dental school. It amazes me how often these SENIOR dental students seem to have NO concept of just how much money they will really make and how hard they will have to work to earn it!

 

[hopefullyadent]

yeaaaaaaaaaaaaaaaaaaaaaaaaaaa

 

[ItsGavinC]

Same thing with pedo - you will see TONS of children and will often see autistic and special needs children, as well as children with emotional and behavioral problems.

I see about 300 patients a week. Probably 1 of those each week is special needs. Maybe 10-15 with emotional or behavioral problems.

MOST of the patients I see are well-behaved and a pleasure to be around. Love it!

 

[ItsGavinC]

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

Yep. That SSC I place on the 3 year old only needs to last for 9 years.

Nevermind all those MO/DOs I do on 6-18 year olds. Those only need to last for, what, 60 years?

Those MIDFL resins I do on #9 certainly don't need to last for longer than a day. Parents like it when they have to replace those each week!

 

[OceanDMD]

Yep. That SSC I place on the 3 year old only needs to last for 9 years.

Nevermind all those MO/DOs I do on 6-18 year olds. Those only need to last for, what, 60 years?

Those MIDFL resins I do on #9 certainly don't need to last for longer than a day. Parents like it when they have to replace those each week!

Come on Gavin, chubby has a point. Tell me you Nevvvvver place that ketac or Fuji as a restoration when the kid is slobering and being a pain in the ass. Band in place, squirt it in, hold the kid down till it dries, and hope it holds for a couple years. Same as placing a pedo class II with just flowable. Bottom line, you can be a little more liberal with baby teeth.

 

[ItsGavinC]

Come on Gavin, chubby has a point. Tell me you Nevvvvver place that ketac or Fuji as a restoration when the kid is slobering and being a pain in the ass. Band in place, squirt it in, hold the kid down till it dries, and hope it holds for a couple years. Same as placing a pedo class II with just flowable. Bottom line, you can be a little more liberal with baby teeth.

Are you being serious? I honestly can't tell.

I have never in my life placed a class 2 restoration with flowable. Not a single one. It will fail, the marginal ridge will crumble, and it will get recurrent decay. Why would I place that? If the kid isn't cooperative so I can do good work they get some sort of sedation or general anesthesia.

I use Ketac occasionally but the restoration is sound and will last. It isn't a half-assed restoration that I placed out of laziness.

It's funny because many general dentists think that holding kids down and slapping in a crappy restoration is the name of the game simply because that's the only tool they have available to them. Those cases are few and far between and I have many other methods I can use if the patient needs them. The idea of being liberal with baby teeth is a concept created by the general dentist to help them sleep at night. It is 100% unethical and borderline malpractice in many situations.

 

[wjdghks]

I see about 300 patients a week. Probably 1 of those each week is special needs. Maybe 10-15 with emotional or behavioral problems.

MOST of the patients I see are well-behaved and a pleasure to be around. Love it!

Just curious, how many hours do you work a day?

Assuming 40hrs, that's 8 minutes per patient I would have thought dealing with kids would mean a longer time per patient, but i guess not.

 

[Stroszeck]

I see about 300 patients a week. Probably 1 of those each week is special needs. Maybe 10-15 with emotional or behavioral problems.

MOST of the patients I see are well-behaved and a pleasure to be around. Love it!

Gavin I really don't know where you practice but sounds like a paradise! Ask ANY pediatric resident or other generals like myself that work part time in a mill working on low income children. There isn't an hour that goes by working on them where you don't get screaming and crying and having to stick a kid into a headlock - and yes inspite of using nitrous. You are painting a very rosy colored portrait here. I wish i worked inyour practice -- kids these days are super smart and know when to expect the needle and writhe around and scream and you gotta worry not to jab their tongues all while the parent is watching you, angry that you can't seem to get the "work done!"

 

[ItsGavinC]

Just curious, how many hours do you work a day?

Assuming 40hrs, that's 8 minutes per patient I would have thought dealing with kids would mean a longer time per patient, but i guess not.

I work about 28 hours a week. My patient time on treatment cases is about 10-15 minutes. Patient time on oral sedations is about 20 minutes. Patient time with recares is about 2 minutes (sometimes 30 seconds, sometimes 5 minutes). Remember that the assistants or hygienist or both are with the patients for a much greater period of time. On those 30 second recare exams the assistant is with the patient for 15 minutes cleaning their teeth, etc.

 

[ItsGavinC]

Gavin I really don't know where you practice but sounds like a paradise! Ask ANY pediatric resident or other generals like myself that work part time in a mill working on low income children. There isn't an hour that goes by working on them where you don't get screaming and crying and having to stick a kid into a headlock - and yes inspite of using nitrous. You are painting a very rosy colored portrait here. I wish i worked inyour practice -- kids these days are super smart and know when to expect the needle and writhe around and scream and you gotta worry not to jab their tongues all while the parent is watching you, angry that you can't seem to get the "work done!"

I work at two different offices in the Phoenix area. One of the offices is very low income, around 90% state Medicaid. Those patients are usually my best patients because they aren't spoiled AND the parents don't try to Google every treatment option you offer. They are also some of the most grateful patients. Some of them are also the most ungrateful because there is little value placed on services that are free to them.

A child's behavior is often a product of your office environment. Pedo dental mills are full of incompetent new graduates that are feeling pressure to produce so they can earn more and meet production goals. This inadvertently leads to shoddy procedures, half-assed work, and borderline abusive treatment of children. This leads to angry children, which leads to angry parents, which leads to doctors blaming their lack of education and ability on the "screaming kids." An associate in such a situation has no vested interest in the practice, and probably rarely sees their own recare patients, so there is no incentive to improve the quality of work or improve patient skills. They enjoy falling back on the "baby teeth will fall out" excuse, which is a complete joke. I see my big rush of cavities in lower-income populations at ages 2-4. So those teeth will be in the mouth for 7-10 years. That doesn't seem like they are falling out any time soon to me.

That is not in any way a statement about you or your dentistry. I doubt you fit that mold at all, but I'm sure you probably see some who you work with that do fit that mold to one degree or another.

The bottom line is that dentistry on children is not dentistry on small adults. The hardest work I do is what I do prior to putting the chair back. After that it's all a cakewalk.

(Re your nitrous comment: nitrous is fairly ineffective in a very anxious child and of course completely ineffective in a crying child. It shouldn't be used as a sedative. It doesn't work. Your office lacks the tools to have you succeed. I don't put screaming kids into a headlock because I don't need to. I don't want to do it and the kid doesn't want to do it so why do it? The only reason is if you have no other way to do treatment, which is what general dentists working in pedo mills are stuck with. It's like a family doctor teling a cardiologist that it sure is tough to do open heart surgery with the patient awake and moving around.)

 

[txlonghorn]

Gavin,

How has the economy affected the practices you work work at? It seems you are still pretty busy, even with the Phoenix area suffering with the recession. Has your income been hurt by the downturn?

 

[txlonghorn]

From looking at http://www.dentaljobscalifornia.com the data seems to be accurate on highest paid specialities.

Are you paid on commission? You seem to be advertising the Cali and Texas sites a lot.

 

[ItsGavinC]

Gavin,

How has the economy affected the practices you work work at? It seems you are still pretty busy, even with the Phoenix area suffering with the recession. Has your income been hurt by the downturn?

Things seem to be picking up again, but it had slowed down a little bit. With pedo you have to factor in Medicaid, which will always be the last thing to go. No politician wants to be the one to take away care from children. So the worst case scenario is you have to see more kids to generate the same revenue. That's possible, to a degree.

But pedo hasn't been hit at all like the other specialties or general dentists. This is also due to the fact that parents will give up their own needs to pay for their children's needs.

My income has gone up over the last 18 months.

 

[txlonghorn]

Things seem to be picking up again, but it had slowed down a little bit. With pedo you have to factor in Medicaid, which will always be the last thing to go. No politician wants to be the one to take away care from children. So the worst case scenario is you have to see more kids to generate the same revenue. That's possible, to a degree.

But pedo hasn't been hit at all like the other specialties or general dentists. This is also due to the fact that parents will give up their own needs to pay for their children's needs.

My income has gone up over the last 18 months.

That is good news! I hope it continues to work out great for you. My fiancé is very interested in pedo and working with low income children (she is working as an RDA for a foundation that provides care to low income children at schools). Are there issues working with Medicaid?Too much paperwork?

 

[DrBadVibes3]

I see about 300 patients a week. Probably 1 of those each week is special needs. Maybe 10-15 with emotional or behavioral problems.

MOST of the patients I see are well-behaved and a pleasure to be around. Love it!

Wow Gavin....you harp on dental mills with your assumptions but your like seeing 80 medicaid patients a day....whats the diff?

Probably not a lot of patient education going on there and when you go around saying things like your patient population is "extremely lazy", I can see they are very lucky to have such a caring and understanding doctor such as yourself.

True, some may be "lazy", but for the most part, alot of these parents are uneducated about oral health and it doesnt help that their dentist spends 30 seconds-2 minutes with them. I guess you gotta pay for that beemer somehow, eh!

 

[DrBadVibes3]

(Re your nitrous comment: nitrous is fairly ineffective in a very anxious child and of course completely ineffective in a crying child. It shouldn't be used as a sedative. It doesn't work. Your office lacks the tools to have you succeed.

not true....nitrous can be a VERY effective anxiolytic if used properly...I think its rude of you to assume that he/she does not have the tools needed to succeed when you're the one that obviously doesnt understand that not everyone needs to rush to the cocktails like yourself.....

if someone is well trained in Nitrous, it can work wonders in pedo.....but then again, if you're spending 30 seconds with the patient, then I can understand how perhaps nitrous doesnt work for ya

 

[SEKDentist]

Don't worry about the money it will come if you earn it. I have been practicing for 22 years as a GP and wouldn't trade any specialists. Specialists tend to get our failures or cases we know will be failures.

I live and work in a rural area. 28 hrs per week in direct patient care. Support staff of 14 is what makes me successful. 3 Hygienists, 4 Front Office, and 7 Dental Assistants. They balance the schedule, work their asses off so I stay calm and cool. The Team generates $1.6M and I take home $750K and we dedicate 1/3 of the practice to treating Medicaid Children and underpriviledged.

The Team works on commission (base salary + % of revenues) and this keeps them motivated. I spend about 4 hours per week tracking our success and looking for ways to keep the practice healthy. Every aspect of the practice is tracked and goals are set to keep the team focused.

Do what you love and refer out what you can't do to near perfection is my motto.

 

[Dent001]

Don't worry about the money it will come if you earn it. I have been practicing for 22 years as a GP and wouldn't trade any specialists. Specialists tend to get our failures or cases we know will be failures.

I live and work in a rural area. 28 hrs per week in direct patient care. Support staff of 14 is what makes me successful. 3 Hygienists, 4 Front Office, and 7 Dental Assistants. They balance the schedule, work their asses off so I stay calm and cool. The Team generates $1.6M and I take home $750K and we dedicate 1/3 of the practice to treating Medicaid Children and underpriviledged.

The Team works on commission (base salary + % of revenues) and this keeps them motivated. I spend about 4 hours per week tracking our success and looking for ways to keep the practice healthy. Every aspect of the practice is tracked and goals are set to keep the team focused.

Do what you love and refer out what you can't do to near perfection is my motto.

wow thats really impressive only 28 hrs a week!?!? Are there any other business strategies you use? What was it like when you first graduated from dental school? How did you get from then to where you are now? Also, do you ever take part in CE courses to stay up to date?

 

[dl9006]

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[ItsGavinC]

not true....nitrous can be a VERY effective anxiolytic if used properly...I think its rude of you to assume that he/she does not have the tools needed to succeed when you're the one that obviously doesnt understand that not everyone needs to rush to the cocktails like yourself.....

Looks like you are back to your old ways of stirring the pot. I 100% agree that nitrous can be very effective if used properly. My point is that it isn't effective in a very anxious child (the type who is breathing through their mouth or possibly crying). The key to getting nitrous to work begins from the moment the patient walks through the door to the office.

I'm not assuming they don't have the tools to succeed, I know they don't. It leaves the children in a poor situation and builds huge levels of dental fear. It also places the dentist in a bad situation and is the cause of poor dentistry. How well can you place a filling on a child if you are holding them down and they are moving?

90%+ of my patients are treated using nitrous only or no nitrous at all. 8% using oral sedation, and the remaining 2% with general anesthesia. Those are stats right out of Dentrix. I like dentistry, but patient management is what I really love. I love working with the kids (as a result, I really do NOT like general anesthesia days).

 

[ItsGavinC]

Wow Gavin....you harp on dental mills with your assumptions but your like seeing 80 medicaid patients a day....whats the diff?

Probably not a lot of patient education going on there and when you go around saying things like your patient population is "extremely lazy", I can see they are very lucky to have such a caring and understanding doctor such as yourself.

True, some may be "lazy", but for the most part, alot of these parents are uneducated about oral health and it doesnt help that their dentist spends 30 seconds-2 minutes with them. I guess you gotta pay for that beemer somehow, eh!

I don't know of a pediatric dentist that doesn't see 60-80 patients a day. That's what pediatric dentistry is. My harp on dental mills has nothing to do with how many patients they see a day. It's the quality of care that is provided. It's whether they care about the patient and do what they would do to their own children. I always treat my patients how I would want my own children treated. Without fail. 100% of the time.

I would be full of myself to assume that my assistants or hygienists can't give better oral hygiene instruction than I can. Trust me, they can. They are excellent at it. Hygiene instruction isn't rocket science.

For the record, laziness and being uneducated about oral hygiene are two different things. Oral hygiene instruction cannot and never will overcome laziness at home. Dentists can rarely change home habits.

 

[ItsGavinC]

Do what you love and refer out what you can't do to near perfection is my motto.

Excellent advice. That's really what it's all about. In regards to this pedo conversation my point is that the guys at the medicaid mills CAN'T refer anything out because the big boss won't let them.

 

[Aphid]

Don't know the situation in the states, but the best paid specialty hands down in Canada is OMFS.

There are very few oral surgeons in canada, and many have no problem attracting patients. Fees are generally very high: 400-500$/tooth, $450/hour of sedation. AND, we don't have medicaid and no discounted insurance plans (ppos, etc). Most surgeons do not even take private insurance. The few that do will charge a co-pay (or "specialist fee") on top of the insurance coverage even if the patient has %100 coverage.

Take home income is probably in the high 6 digits or $1 mill plus. Very very few make less than $500,000...probably new grads.

MD incomes have also increased astronomically in canada in the last 10 years. The MDs have very low overheads (%5-20%) as most of their costs are covered by the government. Their malpractice is also subsidized by the government...so a cardiothoracic surgeon may only pay $5000/year in malpractice insurance. Most family physicans have no problem taking home $250-300k/year. Some of them even bill 800,000k and above if they work in rural areas. No private insurance companies means no discounts. Also, the government will pay what you bill for, no questions asked. Hence there's very little paperwork and politics involved. There was a article in the paper the other day reporting that 90% of opthomologists in Canada made over $1 million in 2009. Why are the MD pay decreasing the states?

Here's list of $$ paid to physicans in BC in 2010....pretty crazy since all hospital based physicans have no overheads! (secretary, nurses are all paid for by the government)

http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2010.pdf

 

[ItsGavinC]

Here's list of $$ paid to physicans in BC in 2010....pretty crazy since all hospital based physicans have no overheads! (secretary, nurses are all paid for by the government)

No different than hospital-based physicians in the US. They are hospital employees (or sometimes independent contractors with private practices outside of the hospital).

I don't see anything different in that link you posted in regards to physician salaries than you would see at various hospitals in the US. I'm speaking as a former hospital employee (as a resident) and the son of a physician employed in hospitals (ER for 15 years then OB/GYN for 12).

What any of this has to do with dentistry I don't know.

 

[justwant]

wut bout oral surgery?