Is ortho dying?

[charlestweed]

The reason these programs don't have any problem filling up their programs is because there are lots of naive pre-dents who do not know what the ROI is going to be and think they can have the life of a dentist / specialists that came out 30 yrs ago when the student loan was fraction of what it is now, cost of ownership was lower, you didn't have to pay $20+ per hour for someone just to hold the suction for you, there were no corporations, cost of living and owning home was significantly lower,...

other reason is the burned out / hopeless GPs out there that are seeing the profit shrinking after covid, cost going up,... and think the way out is more debts ( I am in contact with two of my classmates that did ortho and both complain, mainly saying GPs do not refer)

Dentistry as a profession is not worth it anymore, I honestly don't care enough to type all the reasons but my son for one will not be a dentist (maybe a physician if he has the interest), but there are better professions out there that will not get you in $500K+ in debt for a degree ($700-800K with specializing and probably close to $1M if you end up doing all of it at one of these for profit schools) and you don't need to invest as many years to learn these profession. I see so many stressed, broke dentists (and pharmacists) now living paycheck to paycheck (I'm in southern CA so maybe that's one reason). Unless you are coming from a rich family that your parents could cough up money to cover your tuitions and hand you a practice, then good luck. I don't like this profession and can't wait to get out, but I'm happy I'm not going to dental school now, it is significantly harder now compared to when I came out (10 yrs ago), and I've owned 3 practices, down to 1 now but I am opening another one because honestly at best my current one can only keep me busy for 3days/week (it was busier in 2019 when I opened it but now it's harder to fill the schedule so I have to go back to 6 days/week between 2 practices to keep myself busy (at least that's the idea). So now, I have to go in more debts and work more to stay afloat.

Anyway, best of luck to hopeful dentists/pre-dents, but take the whole advice of "you can pay it back, work harder, see more patients,..." with a grain of salt; there are too many dentists being produced (GPs and specialists), new dental schools popping up, when the supply is high the value goes down and that's exactly what I'm seeing. You have to sell your crown lower to compete with the other dentist that sells it lower (a race to the bottom), PPO INS can keep their fees flat or lower them because there are too many dentist that have no choice but to accept it, medicaid will pay you 40% of your fees because 40% of population are on it and you have no choice but to take it to stay somehow busy (not too busy). and not everybody going to be a superstar dentist, and you can't work harder and make. more if you don't have enough demand/patients walking through your doors.

It seems like you hate what you are doing. I guess that’s why you and I have very different opinions about dentistry. Like you, I practice in CA. Like you, I have to travel to multiple offices to keep myself busy….3 of them are my own offices and 2 are corp offices. I used to work 6 days/wk and travel to 6 offices….. I recently closed 1 of my offices. Like you, I have to keep the treatment fees low to attract more patients. Like you, I open my offices on the weekends to attract more patients. I place all the supply orders myself to control the overhead. I spend a lot of times online to search for cheapest deals…..net32 and ebay are my favorite sites to shop. But unlike you, I don’t hate doing any of these things. I am happy that I am busy. I feel very fortunate that I don’t have problem with patient shortage because I can always get more work days at the corp offices. I don’t mind charging low fees so I can have patients to work on. It’s more depressing to have an empty appointment book.

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[Thehighwind87]

It seems like you hate what you are doing. I guess that’s why you and I have very different opinions about dentistry. Like you, I practice in CA. Like you, I have to travel to multiple offices to keep myself busy….3 of them are my own offices and 2 are corp offices. I used to work 6 days/wk and travel to 6 offices….. I recently closed 1 of my offices. Like you, I have to keep the treatment fees low to attract more patients. Like you, I open my offices on the weekends to attract more patients. I place all the supply orders myself to control the overhead. I spend a lot of times online to search for cheapest deals…..net32 and ebay are my favorite sites to shop. But unlike you, I don’t hate doing any of these things. I am happy that I am busy. I feel very fortunate that I don’t have problem with patient shortage because I can always get more work days at the corp offices. I don’t mind charging low fees so I can have patients to work on. It’s more depressing to have an empty appointment book.

I think a good metaphor for your response is the matrix blue pill red pill argument.

One is ok with the status quo- even if your income declines and you have to work harder year over year, while the other is not ok with the way dentistry is heading- and is either retiring/leaving the profession/not recommending it to others.

It's really a personal decision at this point. Before covid, I was sorta content on running on the treadmill and the blue pill. Sure we have stagnant reimbursement and we don't make "more year over yeave" but I was content, and I honestly saw myself passing off the practice to the kids. It has been around for 40 years.

After covid, and inflation, I said, ok yeah- this ain't gonna work for me or passing the practice onto the kids long term. I mean I'm totally fine on the income and work hour load, but fast forward 10 years- I don't see it working well- or being worth it. By the time my kids takeover- a typical lunch will be 50$ and a filling will be probably less then that. Plan on either selling/semi-retiring that kind of thing before then.

It doesn't take a rocket scientist to see where this profession is heading.

 

[HMI]

It seems like you hate what you are doing. I guess that’s why you and I have very different opinions about dentistry. Like you, I practice in CA. Like you, I have to travel to multiple offices to keep myself busy….3 of them are my own offices and 2 are corp offices. I used to work 6 days/wk and travel to 6 offices….. I recently closed 1 of my offices. Like you, I have to keep the treatment fees low to attract more patients. Like you, I open my offices on the weekends to attract more patients. I place all the supply orders myself to control the overhead. I spend a lot of times online to search for cheapest deals…..net32 and ebay are my favorite sites to shop. But unlike you, I don’t hate doing any of these things. I am happy that I am busy. I feel very fortunate that I don’t have problem with patient shortage because I can always get more work days at the corp offices. I don’t mind charging low fees so I can have patients to work on. It’s more depressing to have an empty appointment book.

Hate is a bit strong, I said I didn't like it anymore. Go read with you wrote, it looks like even you, as a specialist are hustling, my point is why go into this profession if you're gonna became a salesman? the whole idea was you sacrifice your youth, study hard, take exams after exams, boards and... so you don't have to hustle and bargain. Not to mention that healthcare comes with liabilities that most professions don't have to worry about. We can argue, but at the end Pre-dents will do what they wanna do and sign up for dental school and then come and complain once they're out. I do not know why is it so hard to see the profession is heading the wrong way.

 

[Thehighwind87]

Hate is a bit strong, I said I didn't like it anymore. Go read with you wrote, it looks like even you, as a specialist are hustling, my point is why go into this profession if you're gonna became a salesman? the whole idea was you sacrifice your youth, study hard, take exams after exams, boards and... so you don't have to hustle and bargain. Not to mention that healthcare comes with liabilities that most professions don't have to worry about. We can argue, but at the end Pre-dents will do what they wanna do and sign up for dental school and then come and complain once they're out. I do not know why is it so hard to see the profession is heading the wrong way.

Some people are content with the way things are heading. yes if it means seeing more patients and hustling more- for less amounts. But at the same time, I'm pretty sure charles is debt free and living in a 1 mil+ house that is fully paid off etc.

When you have no debt and a decent gig that still pays relatively well- then of course- even if the income declines year over year- it's still not bad compared to the general populace who have average jobs.

But when you have a new guy coming out with boatloads of debt and they are trying to achieve what charles has achieved- then the story becomes very different as they won't have the experience or luxury of the good years of dentistry.

 

[charlestweed]

Go read with you wrote, it looks like even you, as a specialist are hustling,

I’ve been working like this since graduation (in 2001). I didn’t really have any other choices because it’s very saturated here in CA. I wanted to pay off the $450k student loan debt (my wife went to USC) ASAP but I also wanted to have a nice “dentist” lifestyle at same time. So I chose to work 6 days/wk after graduation. Great financial rewards have been the main motivation that keeps me going and going. I wouldn’t love this wonderful profession, if it paid me horribly. Even when I paid off my last debt at 49, I still continued to work 5 days/wk. Last year, I decided to slow down and closed one of my offices….it’s still 17 days/month. I am 51.....and life is beautiful.

I am glad I had worked the way that I did…..hate being in debt. The type of work I do is way easier (and much less stressful) in comparison to what many of my physician friends have to deal with. It’s unfair for these physicians….they are smarter students than me, they’ve worked way harder (both in schools and in the real world) than me, and they make less (per hour) than what I make.

.... my point is why go into this profession if you're gonna became a salesman?

"Saleman” is not a bad term to describe this profession. I do not only have to “sell” cases to the patients but I also have to market my practice to the GPs. When I first started, I had to go door to door to meet the referring GPs. My staff deliver gifts to all my referring GP offices every Xmas holiday. I treat sons and daughters of my referring dentists at a steeply discounted fee. Every profession has its pros and cons. If you are not willing to accept these cons, then you shouldn’t go into dentistry and shouldn’t specialize afterward.

the whole idea was you sacrifice your youth, study hard, take exams after exams, boards and... so you don't have to hustle and bargain. Not to mention that healthcare comes with liabilities that most professions don't have to worry about.

The whole point of going to college (and professional school) and sacrificing the youth years is to learn new skills and to have higher earning potential.....but it does not mean that you can work less after graduation. To make money, you have to keep working hard…and even harder after graduation.

 

[Thehighwind87]

I’ve been working like this since graduation (in 2001). I didn’t really have any other choices because it’s very saturated here in CA. I wanted to pay off the $450k student loan debt (my wife went to USC) ASAP but I also wanted to have a nice “dentist” lifestyle at same time. So I chose to work 6 days/wk after graduation. Great financial rewards have been the main motivation that keeps me going and going. I wouldn’t love this wonderful profession, if it paid me horribly. Even when I paid off my last debt at 49, I still continued to work 5 days/wk. Last year, I decided to slow down and closed one of my offices….it’s still 17 days/month. I am 51.....and life is beautiful.

I am glad I had worked the way that I did…..hate being in debt. The type of work I do is way easier (and much less stressful) in comparison to what many of my physician friends have to deal with. It’s unfair for these physicians….they are smarter students than me, they’ve worked way harder (both in schools and in the real world) than me, and they make less (per hour) than what I make.

"Saleman” is not a bad term to describe this profession. I do not only have to “sell” cases to the patients but I also have to market my practice to the GPs. When I first started, I had to go door to door to meet the referring GPs. My staff deliver gifts to all my referring GP offices every Xmas holiday. I treat sons and daughters of my referring dentists at a steeply discounted fee. Every profession has its pros and cons. If you are not willing to accept these cons, then you shouldn’t go into dentistry and shouldn’t specialize afterward.

The whole point of going to college (and professional school) and sacrificing the youth years is to learn new skills and to have higher earning potential.....but it does not mean that you can work less after graduation. To make money, you have to keep working hard…and even harder after graduation.

Hmm, so you worked through the "golden years" of dentistry. Would you still recommend dentistry today after working 2 decades and seeing where it is going. And what about the debt load?

I think the difference between you and HMI, is that you reflect back on the good years and say- hey its been good to me- what is there to complain about, while HMI looks forward and says- it's been good- but it ain't getting better.

I think we can all agree that dentistry has been good for the past decade, but things post-covid have rapidly changed for the worse, and I personally don't see that light in the tunnel. I personally took a 50-60k paycut in a span of a year from inflation and I personally don't think it will get better.

One can open more days, see more patients, work 6 days a week, to make up for that loss, but I'm not. I'm just gonna accept the paycut, keep saving up money and leave when I have enough to semi-retire/raise the kids/work for a corp. I've accepted the fate, and I would rather enjoy life then trying to figure out how to go OON, open up 6 days a week, work at 3 offices, etc etc.

 

[charlestweed]

Hmm, so you worked through the "golden years" of dentistry. Would you still recommend dentistry today after working 2 decades and seeing where it is going. And what about the debt load?

I think the difference between you and HMI, is that you reflect back on the good years and say- hey its been good to me- what is there to complain about, while HMI looks forward and says- it's been good- but it ain't getting better.

What golden years? These may have been the golden years for dentists/specialists who practiced outside of CA. I remember way back in the late 90s and early 2000s, many of my friends had gone through all the troubles to pass the Nevada state board exam (which required them to make dentures on live patients). That’s because the competition was so fierce here in CA that many dentists/specialists decided to move to NV, where they could make 2-3x more there. If things were good during my years, I wouldn’t have had to work 6 days/wk….I woudn’t have had to charge the low tx fee, which was about half of the national average fee, to attract patients….I wouldn’t have had to work for the corps to supplement my income….it would have taken me less than 20 yrs to pay off all my debts etc.

My view about the “golden years” is different from most here. To me, the “golden years” were not the specific time frame in the past. But instead, they are number of years that a youthful healthy body can handle the heavy workload and long work hours….the years that one is still young, single and have no kids (or have kids but the kids are still very little). So to me, these “golden years” are from ages 20 to 40.....the years that one can potentially produce the highest income (regardless of the state of the economy). So if one chooses to pursue dentistry, he has to accept the fact that he will lose 5-6 years of his “golden years” because of the lenghthy education …..and therefore, working 4 or less days/wk after graduation is not a wise thing to do, especially if one wants to become financially independent as soon as possible. So to answer your question, I would only recommend dentistry to the young 20-21 yo traditional students. I strongly advise against taking a gap year (years). I don’t recommend the older applicants to pursue this field unless they have some saving money (from their previous employments) that can help reduce the student debt load.

I think we can all agree that dentistry has been good for the past decade, but things post-covid have rapidly changed for the worse, and I personally don't see that light in the tunnel. I personally took a 50-60k paycut in a span of a year from inflation and I personally don't think it will get better.

One can open more days, see more patients, work 6 days a week, to make up for that loss, but I'm not. I'm just gonna accept the paycut, keep saving up money and leave when I have enough to semi-retire/raise the kids/work for a corp. I've accepted the fate, and I would rather enjoy life then trying to figure out how to go OON, open up 6 days a week, work at 3 offices, etc etc.

Dentistry has always been a great field….in the past and even now. It’s a business. And just like any business, you have to continue to work hard to maintain the success of your business. The moment you stop putting in the effort, the practice will fall apart….and your staff will become lazy. You are the leader of the practice and you have to set a good example for your staff. Of course, it’s not easy to maintain the same work ethic and have the same motivation when you get older and when all your loans were paid off. And that’s why you start seeing a decline of your practice. And that’s totally fine. You had worked hard during your youth years to pay down the debts + save/invest for your retirement and now it’s time for you to work less and enjoy your semi-retire lifestyle. There are not a lot of professions out there that allow ones to semi-retire in their 50s-60s like dentistry. It’s time for the younger generation to take over….they are the future of the profession.

 

[2TH MVR]

Ortho has been irreparably changed forever. The reasons I went into ortho are no longer valid in this era. Starting a private ortho practice is just so hard. Just too many entities doing ortho now. Too much competition. Too many schools churning out orthodontists. With all this supply of orthodontists coming out of these questionable schools .... our profession has been cheapened somewhat. Think "trade" schools lol.

But. Ortho is still the best lifestyle specialty. I still love treating my patients. The DSOs have taken over. The money is there if you want to work hard like @charlestweed . An employee orthodontist at a DSO is ok at my age. But I went into dentistry to be an owner. A small business owner. Did that for 25 years. Now an employee. Not a bad gig for my situation.

But if I graduated from ortho residency and my ONLY option was to work for a DSO. I would have chosen another career.

 

[Thehighwind87]

Ortho has been irreparably changed forever. The reasons I went into ortho are no longer valid in this era. Starting a private ortho practice is just so hard. Just too many entities doing ortho now. Too much competition. Too many schools churning out orthodontists. With all this supply of orthodontists coming out of these questionable schools .... our profession has been cheapened somewhat. Think "trade" schools lol.

But. Ortho is still the best lifestyle specialty. I still love treating my patients. The DSOs have taken over. The money is there if you want to work hard like @charlestweed . An employee orthodontist at a DSO is ok at my age. But I went into dentistry to be an owner. A small business owner. Did that for 25 years. Now an employee. Not a bad gig for my situation.

But if I graduated from ortho residency and my ONLY option was to work for a DSO. I would have chosen another career.

Usually by the time you hear of the "good gigs" that opportunity is long lost gone. For example: in my high school years 2005ish- it was all the rave- ortho- 4 day workweek- porsche- vacation homes...and now that has changed.

When I was in undergrad- late 2000- pharmacy was ALL the rage. And man that profession changed 1000%- that one is in the dumpster.

When I was a newly minted dentist- and well a current dentist- computer science was and IS all the rage- but with AI and WFH etc- I can see it going the same way as ortho/pharmacy.

Long story made short- when you hear about the best profession etc- and you try to pursue it- thinking you will get all the benefits associated with it- I can probably bet you- you will be late to the party and be stuck with the morsels and not the lifestyle you were thinking about. And in ortho's case- you will be stuck with a boatload of debt.