I figured I should reply here, shed some insider insight on the subject. I even started an account just to do so.
I started an office from scratch with Comfort Dental right out of school. I vowed to do things right, to treat patients the right way, and not to do any of the evils I had always heard from professors about corporate dentistry.
The pros: We had a great standalone building on a busy street bringing in tons of patients. I quickly ramped up until I was producing about $50,000 per month four months in. (I think producing $50,000 is doable for anyone.) We kept overhead under 45%, so we did quite well. My practice loan payments are about $5,000 per month, but I still netted well over $200,000 my first year. Since I was a business owner who had just bought a business, my taxes were insanely low. The following year, I netted over $330,000. That is net after practice payments. On paper it was over $400,000. We see everybody, we treat them well, we call them the next day to see how they are doing, and my margins look just as good as anybody's. Our overhead is now under 40%, and I typically produce a little over 50K per month. Simple math, I take home over $30K per month.
The cons: I work my butt off. I put in well over 40 hours every week at work. Sure, I see patients for only 36 hours. But in order for me to be able to treat them well, I am going over X-rays and treatment plans and medicals for hours, along with running the business. Comfort Dental has NO office managers, so Dr does the books, ordering, payroll, HR crap, etc. Comfort Dental REQUIRES all offices to be open 7:30-7:30 M-F and 7:30-1:30 on Saturday. With three doctors in an office, the recommended schedule is basically four evenings a week and three Saturdays a month. I go home and on my days off just want to sleep. But, I have successfully made a killing seeing Medicaid and treating them just like anyone else. We have no hygienists! That's not mandated by corporate, but it's impossible to keep overhead low with hygienists netting more than some doctors after you take into account student loans and taxes.
The other: Yes, we do a lot of perio. But we see the patients that you don't see. Let me ask you, if you were the only family practice guy in the entire city that accepted Medicaid, and they on average have not been to a dentist in four years, (and many do drugs or just don't brush their teeth,) what percentage do you think would have active perio? AAP says 87%, we are right around 80%. Remember we just see a totally different class than most dentists. That has its pros and cons. The cons are you often chew gum so that you can't smell the perio, or the alcohol, or the pot, or whatever. (By often, pretty much all day.) The pros are they are super grateful for everything, and really easy going, with the exception of the druggies that we kick out ASAP. But most of them realize what great care they are getting at a great price.
Bottom Line: I quickly paid off all of my massive student debt. But I didn't become a dentist to work my butt off, or to work evenings and weekends. I won't be here long.
