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Does Specializing Make Financial Sense?

Discussion in 'Dental Residents and Practicing Dentists' started by El Salvaje, 02.04.12.


  1. Thanks to Crack the NBDE
  1. El Salvaje

    El Salvaje

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    SDN Members don't see this ad. (About Ads)
    Long time no post so I thought I'd give it a go,

    I'll admit right off the bat that I don't understand how economics work especially when it comes to dentistry (that's why I'm asking y'all for some guidance). It seems to me that with the rise in the cost of dental school and the downturn of the economy that becoming a GP makes the most financial sense. I'm not saying that you shouldn't follow your passion but accumulating debt in those extra years of residency (especially if it's unsubsidized and you're from a private schoo) seems to be daunting as well as the fact that I can see GPs refering out a lot less more when times are tight or when technology makes the work easier. Please tell me your input on this given that you are out in the real world experiencing whatever there is to experience first hand as opposed to someone who is in school and just speculating. We've all heard of GPs making more than specialists but is that becuase those GPs who are CAPABLE of it are few and far in between or is it because very few of them WANT to work more than 40 hours a week? You responses are appreciated.
  2. DavesNotHere

    DavesNotHere

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    Yes. Specialists make far more than general pracs.
  3. yappy

    yappy

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    OP: I've thought about this too. Good points. Some hard data can be found at the ADA web site where it lists earnings by specialty. The specialists seem to earn more on average than general dentists.
  4. El Salvaje

    El Salvaje

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    So I realize that specialists make more than GPs on average. My question is why do they make more when a GP has a broader patient base that usually stay for longer periods of time (as opposed to say an orthodontist who has to get new patients every five years lets say) and then with the advent of technology probably be capable of a lot more procedures like endo, extractions or implants that were previously out of their reach. Do GPs just not want to go through the trouble of working longer hours or learning techniques that impose on specialists territory or is there something else going on?
  5. bikedoc

    bikedoc www.wiggleyourtooth.com

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    This is an interesting comment. I have thought long and hard about this topic before making the decision to leave public health and go back and train as a Specialist. I think that it all comes down to speed and efficiency. Specialists are fast at the procedures they perform. If you are doing nothing but Endo, impacted 3rd's, or surgical scaling and root planning, you are going to be fast and have an office that is quite proficient. It means you can do more of these expensive procedure, in less time. Now that doesn't mean GPs are slow, quite the contrary, I know GPs who limit their practice to a certain specialty and they do quite well.

    The economic downturn has caused less spending in implant placement and Cosmetic dental procedures. As a result, more GPs are starting to keep procedures in house, referring out less.
  6. green11782

    green11782

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  7. green11782

    green11782

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    Sorry:

    http:// ***********/dental-specialties/

    dont know why its not letting me post the link
  8. DavesNotHere

    DavesNotHere

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    The procedures they do are fast and make more money.

    Ext 3rds is 1500+ and can be done in 30 min w no materials or lab time

    Endodontists do molar rcts in 20 min

    Ortho is 3-6k per case and they can see 30 pts a day
  9. Kabek

    Kabek

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    I am not an endodontist but I did stay at a Holiday Inn last night. I would have great reservation in anybody that claimed they could do competent molar endo in 20 minutes.
  10. yappy

    yappy

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    Another comment:

    One thing that can add some credence towards what the OP said is that many dental residencies actually charge money instead of paying a stipend the way medical residencies do. Therefore, if someone wanted to become an orthodontist they would have two extra years of interest and two years of opportunity loss in lost wages on top of more tuition.

    I read in the latest ADA salary report that the average orthodontist made 290k/yr while the average general dentist owner made ~220k/yr. I think it would be difficult to justify that financial move unless you really wanted to be an orthodontist.

    Does that line of reasoning seem logical?
  11. El Salvaje

    El Salvaje

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    Exactly my point. Plus if you took out loans wouldn't you also be accumulating interest in those extra years of residency as well? I don't know the average hours worked by each specialty but I would ASSUME that GPs have the potential to make a lot more per hour than specialists especially OMS docs. It's like how many people see that a neurosurgeon makes 500K a year while a GP dentist makes 200K. What they don't factor in is that there is more training required, more debt accumulation, more stress and more hours worked per week for the neurosurgeon to make his salary than it is for the GP to make thiers. Anybody have the average work hours per week by specialty? Does anybody know how much of an opportunity cost debt accumulation through residency is? If you can shed some light on this then I'd really appreciate your input.
  12. Regmata

    Regmata Member

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    LOL, of all the specialties, you think GPs have the best shot at making more per hour than an oral surgeon?
  13. El Salvaje

    El Salvaje

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    Well that goes back to one of my original points. Of course a GP isn't going to make as much as an OMS doing check ups BUT say with the advances in technology they've been telling us about day after day in dental school and the inclusion of CE courses which teach implants why shouldn't a GP charge the the same per hour as an OMS for extracting a 3rd or placing an implant? I've been reading all over this board about how GPs are soon going to take over Endo with the advent of new technology. I'm sure most GPs wouldn't want too but for those that would is it really going to make that big of a difference between the two specialties incomes? Again I'm just trying to learn so I have no idea if these assertations have any creedance or how hard placing implants or back molar root canals are (only a 1st year) but I would like for some of you to share some of your input.
  14. DavesNotHere

    DavesNotHere

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    Not every single one, but watch the brassler endo sequence dvd my man...with 4 rotary drills and a good assistant, that guy chugs it out in 20 min no problem
  15. sarah_bellum

    sarah_bellum ^ ban pls.

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    From an ancient post by the delightful gary_ruska which I repost about 3 times a year:


  16. charlestweed

    charlestweed

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    Both of my friends, who have practiced endodontics for 10+ years, told me that some difficult molar endo cases still take them 1-1.5 hrs or longer to finish. I don't think the ability of the specialists to do things faster than the GPs is the reason why the specialists make more than the GPs. Specialists make more because the procedures they perform are generally more expensive. For example, an OS/perio gets $1200-2000 for placing an implant vs a GP only gets $100-150 for an MOD composite filling. To make the same amount of money as a perio who places 1 dental implant, the GP would have to do 3-4 prophies, 3-4 fillings, and 1 PFM crown prep etc.
    Last edited: 02.06.12
  17. UltimateHombre

    UltimateHombre Doc Holliday D.D.S.

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    I have seen several done in around 30 minutes.... with a microscope, rotary instruments, 3 simple canals, and doing 1000+ a year (like a busy endo)... i don't think 20 minutes in unbelievable.

    Not saying it is the norm, but i think it is definitely believable.
  18. Streetwolf

    Streetwolf Ultra Senior Member

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    Also the specialist's fee for doing a molar endo, for example, will definitely be higher than the GP's fee for doing that same molar endo.
  19. JDIZNEY

    JDIZNEY Grip n Rip

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    "Does Specializing Make Financial Sense?"..... Does a one-legged duck swim in a circle?
  20. agape4unme

    agape4unme

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    good point. i was going to write the exact same thing... a specialist's fee schedule will always be higher than a GP's ...no matter what the procedure. :D
  21. mike3kgt

    mike3kgt Hopefully scuba diving

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    I've heard over and over about the "claim" of 20 minute molar endo. Can it happen, yes. Would you want that done in your mouth? That's a question only you can answer.

    Me? Heck no. My patients? Absolutely not. I've seen the result of the average 20 minute molar endo and it's not pretty. 99% of the time they're sloppily filled or incomplete condensed, or the coronal structure is not well taken care of.

    1 hour molar endo is more appropriate, I've seen most endodontists use this as a gauge for scheduling. But hey, $1500 an hour production isn't too bad ;)
  22. duknowme

    duknowme

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    Just because one person does something faster or slower is not always an indicator of the quality. Just like the cost of a procedure is not an indication of quality.

    For example. I have seen an Oral surgeon sedate, extract 4 impacted thirds and wake up a patient in about 15 min on a regular basis. A general dentist typically is not able to do this. This is mostly because the Oral surgeon has done this about a thousand times more that the GP. I would be willing to say that that patient will also probably have fewer complications than if someone took 2 hours to do the same thing. I would be willing to say that the same thing applies to Endo or anything else for that matter.
  23. Lethstang

    Lethstang

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    Specialists make more predominantly because of their overhead.

    General practices are healthy in the 40-60% range, with 55-60 being normal. Ortho/endo/omfs can get down to the 30-35% range, which on a 1m grossing practice is a bump of 200ish k a year take home pre tax.

    Its a common misconception specialiasts offices gross more than GP. Its all about the OH and what they take home.

    however this model is a bit skewed when taking into account omfs. they gross far more and OH is far less. Its a GD money pump.
  24. CustomerAmerica

    CustomerAmerica Professional SEO Magician

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    Easy. There are fewer specialists (hence them being so *special*), the people seeking their services are willing to pay more for a *special* specialist and specialists tend to have their marketing on point.

    IMO, of course... based on my experience with clients. :thumbup:
  25. El Salvaje

    El Salvaje

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    So a GP and an Endodontist do the exact same procedure does the Endo get to bill more than than the GP? It seems that with CE courses closing the gap there doesn't seem to be any reason why a GP should be charged less than a specialist for an identical procedure.
  26. live

    live

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    You're right. If a GP can do an ENDO retreat (when a broken file is in the apex or a Max 1st turns out to have four roots and five canals) with no microscope as well as the Endosontist OR remove Class 3 impacted wizzies as well, as safe, and deal with the complications as well as an oral surgeon then sure he can charge the same thing. Remember, you never know when a case will go south and if all you ever send to your specialist buddies are these cases once you've attempted them you may start getting the "I'm booked up for the next 2 weeks, sorry" responses. Just my .02 bc everyone is different
  27. duknowme

    duknowme

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    I couldn't agree more. It is also important to remember that you don't know what you don't know in many cases. As you get further along in your education you will realize that the more you learn about something the more you realize you don't know.

    The reason specialists get paid more for doing the same exact procedure is because you are paying for the expertise and experience.

    Another point I would like to make is that with the extra training a specialist gets comes a better ability to handle complications. Anyone can extract a tooth. But knowing what to do if you have a sinus perforation that leads to an oroantral fistula, or a nasty post-op infection that requires an extraoral I&D or any other number of complications is a totally different thing. That is what specialists get paid for.
  28. PTBarnum

    PTBarnum

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    Although specialists are able to charge more for their procedures and do them quicker, are they actually able to fill up their schedules in this recession? It seems that a lot of GP's are referring out less and patients are more reluctant to pay the premium cost for a specialist, especially if they are pinching pennies.
  29. Michael Scarn

    Michael Scarn

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    CE courses could never close the gap on legit training. Maybe in the GPs mind, but certainly not in reality.
  30. TJNova2011

    TJNova2011

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    There's a few gp on dental town that limit their practice to only endo. They been doing it for years and does amazing work. In fact he even has an endodontist as an associate! Legit or not, if you do root canals day in and day out and invest in yourself you can get pretty good at them. It's not rocket science...
  31. Lethstang

    Lethstang

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    very untrue. lol.
  32. DavesNotHere

    DavesNotHere

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    Well, I think it probably depends on the topic a lot...but IMHO CE should only be used for modifying an already learned technique or learning a new piece of technology
  33. Michael Scarn

    Michael Scarn

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    You must be a GP who is doing CE courses in place of a residency.
    Like I said, in your own mind...

    To say that CE courses take the place of a several year residency is laughable. Now if you want to say that years of practice and lots of procedures do then I'll agree. But if you are doing procedures on patients that you aren't as familiar with or only were exposed to in a CE course then you are essentially doing a mini residency in your office (with no expert supervision) which means you are likely having a lot of failures. Not a great practice builder (and not super ethical in my mind).

    As stated it largely depends on the procedure as invisilign is gonna be more straight forward than SARPE.
  34. duknowme

    duknowme

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    I think this is true but it also depends on the procedure. I think that a GP has every right to do endo because they get trained to do it. And if they do it enough they could theoretically become as skilled as an endodontists. And if that GP starts to do only ENDO all day long than his skills are definately going to get better. However, if a GP never gets any formal training on a certain type of procedure, usually a weekend CE course will only serve to get you into trouble. I have seen the results of this first hand.
  35. duknowme

    duknowme

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    "But if you are doing procedures on patients that you aren't as familiar with or only were exposed to in a CE course then you are essentially doing a mini residency in your office (with no expert supervision) which means you are likely having a lot of failures. Not a great practice builder (and not super ethical in my mind). "

    couldn't agree more.
  36. Lethstang

    Lethstang

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    yes i agree. no one said a ce course is equal to a residency. calm down fella.
  37. UltimateHombre

    UltimateHombre Doc Holliday D.D.S.

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    I would imagine it would be difficult for a GP to limit his practice to endo, simply because they will not have the referral pool needed. Not to mention, how could a GP just start scheduling endo all day... just seems very improbable to me.

    Furthermore, i heard a statistic (sorry no source), but seems accurate: GP does an average of 2-5 RCT a week. Endo's do 20-30 RCT a week. At this rate, how would a GP ever expect to be as proficient as an Endo?

    Not trying to create waves, just trying to understand the logic behind a GP being as proficient as any specialist?
  38. green11782

    green11782

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    If specializing was equal to a gp doing enough ce classes to be considered an expert then there wouldn't be specialists out there. Sorry but no, never will specializing and ce be the same...enough said. :)
  39. DavesNotHere

    DavesNotHere

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    Depends on the area. In small towns/rural settings, the gps can tend to become "specialists"...especially w endo, pedo, and exodontia
  40. bigbadaboom

    bigbadaboom

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    http://www.dental-tribune.com/articles/content/scope/news/region/usa/id/7505

    According to CareerBuilder, oral pathologists had average pay of $188,577 in 2010 compared with $159,759 in 2009; periodontists had average pay of $177,084 in 2010 compared with $150,023
 in 2009; and the average endodontist earned $166,874
 in 2010, up from an average of $141,373
 in 2009.
    Dental specialists aren't the only ones with big increases in pay. According to the same survey results, pharmacologists earned $99,370 in 2010, up 10.4 percent from $90,012 in 2009; 
toxicologists earned $70,273 in 2010, up 10.4 percent from $63,655 in 2009; and academic deans earned $100,771 in 2010, up 8.2 percent from $93,126
 in 2009.
  41. DavesNotHere

    DavesNotHere

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    Those sites don't reflect health professionals' pay accurately.:sleep:
  42. UCSD6

    UCSD6

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    those sites don't include private practitioners which include about 80% of the workforce
  43. uva09

    uva09

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    On the surface, I don't think anyone can argue that specialists, on average, make more money and have greater income potential.

    That being said, there is an economic fact to consider with regards to the opportunity cost and forgone year(s) of income. It will simply take time to make up for the lost time and, often, increased costs associated with specializing.

    To play devil's advocate here, a GP could graduate into a family business and begin earning money from day one with guaranteed equity. Therefore, he/she is making 250k+ for 6+ years while your pal in OMS isn't making anything worthwhile and sitting on mounting debt and new medical school debt. Here is where the time value of money comes in - and with what could be a ~6-10 year head start, a wise practitioner with some business/investment sense could make it take a long time for his/her OMS compadre to play financial catch up, even with double the salary.

    If the ultimate goal is to make as much money as possible then, regardless of specialization, you need to become more businessman than dentist. Own your own practice, thrive, expand, buy additional practices. Keep overhead down. Make smart choices. A GP can become a millionaire if he/she is business savvy and not prohibitively risk averse. And you don't have to be in Ortho or OMS to do this. This is the beauty of the industry.

    As to the original prompt? Yes, specializing, usually, makes financial sense. But like anything else, it just depends on the individual and his/her financial situation, personal situation, etc.
  44. McKnightRider

    McKnightRider Quantum Solace

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    Are there cliff notes for your posts? And why is a dental student giving advice on every thread in the residents section?
  45. uva09

    uva09

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    Haha, I'm sorry McKnightRider - was that above your reading level? Thank you for the mature contribution. And you do realize - anyone can select 'dentist' as their status, right? Real dentists get their status verified by SDN. Though it is interesting that only 'dentists' without the SDN verification avatar make juvenile comments such as yours. Keep up the good work in India.
  46. avangusva

    avangusva

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    Wow you have a serious issue, I've seen your other posts complaining about others posting. It's quite immature if you ask me...
  47. McKnightRider

    McKnightRider Quantum Solace

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    Noted.

    I'm under the impression that the Resident section of the forums should be for residents to discuss issues and dental or pre dental to ask questions of the residents.

    Anything else should be in the proper forum.
  48. clarkbar

    clarkbar

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    I've always wondered about these reported salaries. Is there anything in the pudding we should know to gauge their results? Thank you.
  49. clarkbar

    clarkbar

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  50. bigbadaboom

    bigbadaboom

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    250k from day one is overly optimistic.

    try 50k the first year in California, if you're even lucky enough to find a job as a recent grad <3 yrs out of school.

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