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Keep the questions coming. I'm headed on a 10 day vaca out of the country and won't be able to reply for a while. Keep them coming!
Possibly. I have many friends who are in the military. From a financial standpoint it is very attractive. The biggest part of the financial package to me is that you will not be accruing interest in school or when you get out. I paid so much extra money in interest it was crazy.
I have friends in the army that only place amalgam restorations. They are amazing at it; however, they are not allowed to do endo and they send out their crowns to civilian dentists. They are behind from a clinical stand point and from a practice management standpoint. They complain constantly about how little control they have and how their assistants get to boss them around. I have four friends who tell me these stories. Keep in mind that they are all at the same post. I'm sure there are amazing army jobs out there with the exact opposite experience.
I also have three friends from the air force. They came out with all the skills needed to start practice right away. Implants, complicated 3rd removal and complicated endo.
So the answer could be yes or no! Thats the scary part.
The Army guys- where are they posted? Can be a PM if you want to maintain their privacy. Did they do AEGDs before their payback tours?
I suspect there is one of two reasons why they are on the amalgam line:
1) No AEGD/they did a credentialing tour
Or
2) They are on a large Army base which has a high amount of specialists that take the Endo etc. cases
Assistants bossing them around? Doesn't sound right. They are officers and assistants are enlisted personnel. They outrank the assistants.
That is still a lot of debt. It will haunt you. Make sure you manage it well, and if you have a high income and low expenses you can knock it out relatively quickly. The debt that we take on as dental students puts us significantly behind the rest of our peers. I still feel behind some of my friends because of the debt I had to pay off. I think about how much I could have done with the 310 that I paid off in student loans if I did something else with the money.
I think about how much I could have done with the 310 that I paid off in student loans if I did something else with the money.
The Army guys- where are they posted? Can be a PM if you want to maintain their privacy. Did they do AEGDs before their payback tours?
I suspect there is one of two reasons why they are on the amalgam line:
1) No AEGD/they did a credentialing tour
Or
2) They are on a large Army base which has a high amount of specialists that take the Endo etc. cases
Assistants bossing them around? Doesn't sound right. They are officers and assistants are enlisted personnel. They outrank the assistants.
Figured I'd chime in here since Im just finishing my first year of Army HPSP payback. Im also a long-time sdn lurker lol.
Im stationed at a big Army post with 3 residencies. I'm at the one of the busiest dental clinics in the Army in terms of # of soldiers. Some of the issues the OP mentioned ring true in my clinic. LOTS of amalgams with a few crowns peppered in and some 3rd molar surgeries. I do pulpectomies then send it to residency. You can schedule one day per week of crown/bridge work or surgeries which I do. But you have to stay on top of them about that or they will fill your books with operative. The one year program is apparently good, but it doesn't credential you for anything additional so you can lose the skills you gained in that year. The two year program credentials you to do more. If I don't do a specialty, I may do a VA or private GPR before transitioning to private practice but we'll see.
Assistants are contract workers with a strong union, not soldiers. A lot them are bad. I had a bad one to start with. She was 30mins late most days and when I talked to her about it she told me "We're a team. which means if I'm late, you should set up the chair and seat the patient, otherwise I'll get written up for being late"...... Needless to say I requested a new assistant and luckily got a good one. They are pretty much un-fireable.
Anyway, I won't ramble anymore but there. Ill still be better than I was graduating dental school, and won't have school debt. You can also moonlight in private practice which I plan to do once I get a the appropriate state license. PM if you have questions so I don't derail this into a military post
Figured I'd chime in here since Im just finishing my first year of Army HPSP payback. Im also a long-time sdn lurker lol.
Im stationed at a big Army post with 3 residencies. I'm at the one of the busiest dental clinics in the Army in terms of # of soldiers. Some of the issues the OP mentioned ring true in my clinic. LOTS of amalgams with a few crowns peppered in and some 3rd molar surgeries. I do pulpectomies then send it to residency. You can schedule one day per week of crown/bridge work or surgeries which I do. But you have to stay on top of them about that or they will fill your books with operative. The one year program is apparently good, but it doesn't credential you for anything additional so you can lose the skills you gained in that year. The two year program credentials you to do more. If I don't do a specialty, I may do a VA or private GPR before transitioning to private practice but we'll see.
Assistants are contract workers with a strong union, not soldiers. A lot them are bad. I had a bad one to start with. She was 30mins late most days and when I talked to her about it she told me "We're a team. which means if I'm late, you should set up the chair and seat the patient, otherwise I'll get written up for being late"...... Needless to say I requested a new assistant and luckily got a good one. They are pretty much un-fireable.
Anyway, I won't ramble anymore but there. Ill still be better than I was graduating dental school, and won't have school debt. You can also moonlight in private practice which I plan to do once I get a the appropriate state license. PM if you have questions so I don't derail this into a military post
Assistants are contract workers with a strong union, not soldiers. A lot them are bad. I had a bad one to start with.
Kind of veering into off-topic territory with this, but are they government employees or private contractors? I used to do DoD contracting and the expectation absolutely was that we kept things locked down so our colleagues on the government side could be late or spend 4 hours per day filling out forms from HR.
It always annoys me when I read that its not uncommon for them to not use your skills and stick you with routine procedures.
vasco, you're doing awesome! This is what I would want to hear if I was at NYU and sweating the debt load. But just to inject a cautionary note:
1. vasco's income trajectory is way above the average for new dentists in most parts of the country. NC is a good state to practice in but he's done exceptionally well even so. For financial planning purposes, don't assume you will be able to match his success. Some yes, most no. I graduated in 2011. Had classmates who've done this well but it's been the exception. Many made 100-150K first year out. As the years go on people have started to diverge more and more in terms of income and skill set (depending on speed, drive, business instincts, ambition, and location). Near as I can tell the average now we're four years out is still well sub-200k, some much lower due to new startups or practice purchase loan payback; some vascos in the mix too, so yes it is possible.
2. Here's one deceptively simple fact I didn't fully appreciate the meaning of until I graduated and started working: unless you get to the point of having associates working for you, every penny you make will come from your own hands. A dental degree is worth NOTHING. It's a piece of paper. It's the WORK that piece of paper legally permits you to produce that has value. You will need to bust a** to earn deep into six figures: i.e. working out of multiple rooms yourself plus checking hygienists. Some days you'll feel like a chicken with his head cut off trying to keep on schedule. You will go home exhausted. You will recall the days of seeing two patients a day in D4 year with nostalgia and disbelief. This is one of those things you "know" intellectually even before you get to dental school, but doesn't hit you as a daily reality until you are out and doing it day in, day out. I repeat: you are going to bust your a** to make deep into six figures.
Corollary to all this, and my motive for posting, is to emphasize -- if you are in a position to minimize school debt, do so.
Assistants bossing them around? Doesn't sound right. They are officers and assistants are enlisted personnel. They outrank the assistants.
Not sure if this was asked yet but...
1. Summer before D1, what should i do? Any reccomendations for travel?
2. What did you find most difficult in D1. Keeping up w/ lecture material (path, micro etc) or learning hand skill in sim?
3. Can you give us a rundown of what a typical day in d1/d2 would have been like and compare that to typical d3/d4 and then maybe compare that to typical work day. Alot to ask i know haha.
Thanks again this thread is great
How was it moving from Ohio to NC?
And as waldo said, thank you for your post and time!
Can you throw some ideas out here about what you think you would do with that money? investments? rental properties?
ALSO, three more questions-
1) Have you been fully funding your retirement accounts while paying back loans?
2) Of the ~300K a year, what percentage of that is your discretionary income, which I consider to be income after taxes, after insurance, and mandatory professional/licensing fees?
3) I'm looking at a school that will cost me ~255K in loans all inclusive....with about a 70% chance to get that down to ~180K. Suppose I didn't get accepted for the HPSP - do you have any estimates on how quickly I can kill my debt, assuming a frugal living after dental school?
Thank you for your time!
Question for @BrazilianRider - How long do you anticipate taking to pay off that debt?
To OP, thank you for sharing your success and advice. If you don't mind, I have a couple questions:
1) Did patients ever complain about your jumping around rooms treating multiple patients? How did you communicate to them so they don't raise this complaint?
2) What made you settle in NC?
3) Are you running any advertisements? How are you obtaining new patients in your new office, or are most of them old patients?
4) How many hygienists and associates in your new office?
5) Do you think your salary is on par with specialists in the area?
6) Any general opinions or advice to dental students about specializing?
Thanks!
2. Here's one deceptively simple fact I didn't fully appreciate the meaning of until I graduated and started working: unless you get to the point of having associates working for you, every penny you make will come from your own hands. A dental degree is worth NOTHING. It's a piece of paper. It's the WORK that piece of paper legally permits you to produce that has value. You will need to bust a** to earn deep into six figures: i.e. working out of multiple rooms yourself plus checking hygienists. Some days you'll feel like a chicken with his head cut off trying to keep on schedule. You will go home exhausted. You will recall the days of seeing two patients a day in D4 year with nostalgia and disbelief. This is one of those things you "know" intellectually even before you get to dental school, but doesn't hit you as a daily reality until you are out and doing it day in, day out. I repeat: you are going to bust your a** to make deep into six figures.
.
Keep in mind that I don't have first hand knowledge....but my friends who complained about it had horror stories. One example was that the dentist was doing a root canal. He wanted his assistant to hold his endo ring in a certain location so that it was easier for him to do the procedure. When he asked her to hold it a certain way the assistant looked at him and in front of the patient said "excuse me? how long have you been a dentist?" And refused to hold the endo ring where he wanted it. The dentist order her out of the room and he finished the procedure by himself.
He complained to his boss about the assistant.......and guess what happened....later that week he was forced to officially apologize to the assistant by his superior officer.
This was the stuff that drove my dentist friends nuts.
Of course this is just their experience at one base and most likely isn't the norm.
0) I would have invested in the stock market, rental properties, and saved for down payment on practice.
1) I did not. And it wasn't smart. The first thing they teach you in business school is time value of money. I unwisely put all my money towards the loans. I had an unhealthy relationship with my student loans. I wanted them gone as soon as possible. I would without a doubt recommend fully funding retirement while paying off you student loans.
2) You will find if you haven't experience it already...that everyones tax situation can be very different. The % here is based my gross income - taxes - the fees you listed.
2010 - 69%
2011 - 74%
2012 - 72%
2013 - 70%
2014 - Not sure yet but probably around 70%ish maybe less maybe 68%?
3) Not guesses here. If you make good money and live frugally you should be able to pay your loans of in a relatively short amount of time. Like a previous poster mentioned......to make good money you have to work hard. Be prepared for it.
Keep in mind that I don't have first hand knowledge....but my friends who complained about it had horror stories. One example was that the dentist was doing a root canal. He wanted his assistant to hold his endo ring in a certain location so that it was easier for him to do the procedure. When he asked her to hold it a certain way the assistant looked at him and in front of the patient said "excuse me? how long have you been a dentist?" And refused to hold the endo ring where he wanted it. The dentist order her out of the room and he finished the procedure by himself.
He complained to his boss about the assistant.......and guess what happened....later that week he was forced to officially apologize to the assistant by his superior officer.
This was the stuff that drove my dentist friends nuts.
Of course this is just their experience at one base and most likely isn't the norm.
Might be a silly question but would you say that the dental school you attended influences how productive and happy you end up becoming as a dentist? or would you say that it is mostly the characteristics that you have mentioned that determine where and how you end up?
How much does good CE usually end up costing you each year? Is it a significant cost?
How much does good CE usually end up costing you each year? Is it a significant cost?
Does it matter in practice if you attend CE at a prestigious institution or not really?Totally depends. I've done lots of little CE that has cost around 300 dollars or so. My big ticket ones were:
1). Productive dentist academy. 2500
2). Six month smiles. 3000
3). Triangle implant dental institute. 9000.
There are some much more expensive CEs out there as well.
Does it matter in practice if you attend CE at a prestigious institution or not really?
What were the pros and cons of the triangle implant ce you took ? Did you feel like you could start placing implants after that ?
Have you looked at opening multiple offices? Why or why not? If so, do you think a monopoly on one town or spread out over the region is best?
What do you mean by "dilution"?I have. Owning multiple offices bring some appealing business opportunities.
Let me detail a few benefits and negatives.
Benefits:
1). It allows you to make passive income. True wealthy people make money by not using their own two hands. In dentistry we are service providers. We make money by using our hands for the most part. To drive true wealth you have to look beyond your own powers of dentistry. Owning multiple locations allows you to earn passive income....even when your won handpiece isn't spinning.
2). Brand awareness. You brand will increase in the city or region you are in.
3). Cost sharing. Marketing can cost a lot of money if you hit it hard. If you spend 20 k marketing one office...the second you other office is profitable then each office pays 10k for marketing.
4). Possibility to increase insurance fees with more offices.
5). Possibility to lower supply costs.
Negatives:
1). Dilution. Some dentists think they are ready for office number two...get it all set up and going and they end up making just as much as they did when they were in one office and now they have twice the head ache. This happens frequently. Those that I have seen have this happen to them didn't know how to properly manage the business aspect of dentistry.
2). Hardest part of spreading your brand is cloning yourself. No one else will ever care as much as you or treat patients exactly the way you want them to. Having associates be exactly how you want them to be is so hard. Don't underestimate this.
3). If you are not in love with business you need to get a partner who is. If not owning multiple offices is a challenge.
I'm sure there are more. Those are just off the top of my head. I'll think of more and edit this post to add them.
Whether to own many in your one city or a region depends on how much you want to travel and be away. Staying local has power for local brand management and the flexibility of travel.
Owner outside the city opens up new markets and demographics but forces you to travel more.
As with anything....totally depends on the situation, city, region, and competition.
I believe he means that his income with 2 offices can potentially get diluted. So making 300k at one office one would think to make 400k+ at two offices (arbitrary income) but in reality he is making 300k at two offices, diluting his income between 2 offices, and in the end making the same as before.What do you mean by "dilution"?
What do you mean by "dilution"?
OP, did you need a 20% down payment on your practice? How do banks deal with preexisting debt and mortgages when you want to buy a practice?
I used a small business loan and they only asked for 25k down. I was shocked that they didn't want more. All banks will run certain ratios on you to see if you are a good possible client and will take into consideration cash on hand and collateral options. Obtaining a loan as a dentist is usually easier then most other small businesses.
One thing that you will want to watch out for is when you purchase a house using a standard mortgage. If you are an associate getting ready to buy or start a practice it is better to purchase your house while you are still getting paid as a w2 employee. When you are a business owner they want two years of financial history at your practice before they will loan you money. If you attempt to obtain a mortgage at year one of owning your office they will take your earnings from year one and divide it by 24 months to obtain your monthly income. So if it makes sense to purchase while you are still a w2 employee then that will save you some time. There are some ways around this such as a portfolio loan.
That's one of the issue I'm trying to decide so I know what I can do next. If I get the house, I'll have a mortgage which more than likely be three times the amount I pay for rent as of now, but If I get the clinic It'll give me the chance to at least double my yearly net in a year or two, but purchasing the house will have to wait a little longer, but my overall net flow yearly would probably be a little more than now. Sigh, grown up problems.
That's one of the issue I'm trying to decide so I know what I can do next. If I get the house, I'll have a mortgage which more than likely be three times the amount I pay for rent as of now, but If I get the clinic It'll give me the chance to at least double my yearly net in a year or two, but purchasing the house will have to wait a little longer, but my overall net flow yearly would probably be a little more than now. Sigh, grown up problems.
Would you say that your success is somewhat an anomaly? Financially speaking, would specializing be a better option or is general dentistry (with a bit of elbow grease) capable of earning equal or greater amounts of money? You mentioned that as an associate you were already making 300k+ per year, which is the median income of most specialties. Also, are pediatric dentists able to work on adults as well? A pediatric dentist I shadowed worked on both and also did implants + invisalign, which likely upped his income by a lot.
1) Would you say that your success is somewhat an anomaly?
Is sortof an answer? There are plenty of associates out there that earn that much money. The ones that I have worked with and have knowledge of have the "productive characterists" that I detailed in this post. I know more associates that make less then I did, than make in the 300 range. Here is a list of friends that I know who are associates and what they made last year. All in different parts of the country. One is in corporate and the rest are in private practice.
1) 250 molar endo, c and b
2) 200
3) 320 molar endo, heavy c and b
4) 350 implants, six month smiles, invisalign, molar endo, heavy c and b
5) 300 implants, six month smiles, molar endo, heavy c and b
6) 210
7) 200
8) 400 (corporate) mostly extractions and dentures
9) 170
10) 200
11) 250 molar endo, c and b
The ones that made the most all have in common those "productive characteristics". The rest of them either are missing a couple characteristics or don't have any of them. The best way to be successful in life is to spend your time learning from other successful people. My original post was based on what I learned from watching and listening to highly successful dentists. Some were practice owners and some were just associates.
2) Financially speaking, would specializing be a better option or is general dentistry (with a bit of elbow grease) capable of earning equal or greater amounts of money
It is so hard to play the income game. I understand why we do....its just so hard to get concrete data that translates to individuals. I can tell you what I have seen personally. On average my friends who are specialists make more money then my friends who are GPs. The dentists that I know that make more money then the specialists are excellent GPs that own their own office and offer a broad procedural mix and have low overheads, or large offices that have an economy of scale.
If you want to make more then everyone then you are a GP who owns and operate many practices. The people that I know that do this make 7 figures.
3) Also, are pediatric dentists able to work on adults as well? A pediatric dentist I shadowed worked on both and also did implants + invisalign, which likely upped his income by a lot.
I've never seen or heard of a pediatric dentist that works on adults. I've seen some work on teenage kids; however, they usually age out at 18 or so. I guess every state is different, but that would be really odd in my neck of the woods. GPs are very territorial when it comes to the people they refer to infringing on their possible revenue. For example I wouldn't refer any of my pediatric patients to a pediatric dentist who was doing implants, braces on adults. You wanted to devote your life to pedo....do pedo.