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The Most Stable Specialties In Dentistry?

Discussion in 'Dental' started by El Salvaje, 03.15.12.


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  1. El Salvaje

    El Salvaje

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    What is the most stable specialty in terms of a) being able to ride hard economic times the best which is something I have heard Ortho has trouble with since it is seen as mostly a cosmetic feature b) being able to resist the advent of technology for the current time being which is what I've heard Endo has had trouble with and c) convincing enough GPs to refer to them rather than doing their own procedures in house which I imagine Pedos would have a hard time doing considering that no one that I grew up with has ever gone to a pedo or even knew that the specialty existed.

    In my opinion I'd say General Dentistry is the safest seeing as to how you can do a variety of procedures (ie not limiting yourself to one area) followed by OMS which always has complex hospital procedures and the speed of placing implants/taking out 3rds which currently no other specialty can compare with.


    Any thoughts or ideas?
     
  2. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    Pedo...they always do well...kids will always exist...parents get their kids treated even when they can't afford it for themselves...and if u can do a little ortho yourself you can really clean up
     
  3. yappy

    yappy

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    Interestly, it's been my observation that many parents I know are also very concerned about their kids' physical appearence. Even though they neglect their own dentition they're taking their kids to see the orthodontist and working out payment plans.

    They want their kids to be healthy and look good in order to have confidence and be successful. Not a bad angle...


     
  4. DrJeff

    DrJeff Senior Member Moderator

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    Agree 100%!!! Great reason to be a GP, you can do whatever you want (and feel comfortable doing) across all disciplines of dentistry, and then when you either have a case that you don't feel comfortable with (such as a molar endo on #15 with roots that are curved about 30 degrees to the distal on a patient with limited opening and a high saliva flow rate who's also very anxious and has an annoying personality :eek::D:eek::D ) you can just refer them to your local specialist who will then have to find a way to both manage that patient and "thank" you for the referral as their stress level goes up a bunch and your stress level decreases a bunch ;) You can have the best of both worlds as a GP for sure! :D
     
  5. mixoma

    mixoma

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    I would say GP just for the fact that when things get slow you can keep more in house and can do most things a specialist can do, maybe not as fast or as good as them but you can do it, and most patient would rather you do it anyways. Regardless if you specialize or not you will most likely find work in any area of dentistry but I know orthodontists and periodontists who have seen there incomes go down due to the poor economy, and the GP's I know are mostly consistent year to year income wise. Peds do well regardless cause of medicaid, the same goes for OS as not to many dentist want to do full bony impacted thirds.
     
  6. charlestweed

    charlestweed

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    To minimize the stress level and the risk of losing the dental license, many general dentists still have to refer difficult cases to the specialists. Not every general dentist has the experience to do everything. Even the experienced general dentist like Dr.Jeff still has to refer endo cases to the endodontist.

    If the specialist knows how to control his/her overhead, he/she only needs to work 5-6 days/month….and for the other days, he/she can travel to other offices (dental chain or private GP practices) to work as an in-house specialist. Every time the OS (my dental school classmate) comes to work at the chain clinic, he does, on the average, 5-6 third molar cases per day. He didn't tell me how much he makes per day but I am sure it is easily the same as what an associate general dentist makes in a week.
     
    Last edited: 03.16.12
  7. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    Yeah I'm not sure what you guys mean by "safest being a GP". In economic down times...like now...specialists are still out-earning GPs by a lot on average.
     
  8. El Salvaje

    El Salvaje

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    I feel like the reason GPs get out earned by most specialists is because generally the GPs don't WANT to pursue certain cases and the ones who do (by taking CE courses to become more proficient in molar endo or bony exts or dealing with kids/doing cosmetic cases) really can't be touched. Also, don't GPs get kick backs on their referals in terms of a certain percentage of the procedures they refer out or is that just in certain situations? I'd say that also factors into their decision to let certain cases go rather than just do it themselves.
     
  9. HBaller

    HBaller

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    I went to a Levin Group Seminar last year and he answered this exact question... This is based off of his 25+ years of statistical analysis from working with GP's and all dental specialists.

    Oral surgery is the most stable.

    Ortho has the highest growth potential.
     
  10. CaliDDS1986

    CaliDDS1986

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    Used to.
     
  11. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    That's not true. If a GP could make more money doing anything differently...they would. No one is choosing to make less money by avoiding procedures on that regular of a basis.
     
  12. ortho lurker

    ortho lurker

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    Kick backs are uh.....illegal (not that they don't happen). Is it worth losing your dental license if you got caught?
     
  13. Bereno

    Bereno Smoking Monkey

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    This thread is asking what the most stable specialty is... Since when has general dentistry been a specialty? lol

    OP: when you ask about stability, I think you need to clarify what you mean. Do you mean most stable as in having consistent work, or do you mean stable as in most financially stable?
     
  14. El Salvaje

    El Salvaje

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    1. Yes I know plenty of GPs with a wide spectrum of skills and the only reason for this is because some of them chose to partake in CE courses to get better in a field they think they were refering out too much (like implants or tricky endo cases) and others who didn't want to bother refer everything out despite the lost profit potential. People forget that those who generally go the GP route are laid back enough or are more concerned with having a good lifestyle to the point where they aren't maximizing their income. It is almost Zen in a way where the practitioner realizes that the extra stress and hassle of trying to make a million dollars a year isn't worth sacrificing time with their family or attempting to learn difficult procedures. I'm sure there are people on this forum who can tell a story about "I know a guy who does all of his own endo and extract thirds" and it will be about none other than an ambitious General Dentist.

    2. To the poster who said that OMS was the most stable but Ortho had the most growth potential, I can understand how the first part would be true but not the second part at all. With GP and Pedo you essentially have a base clientel which will keep coming back for many, many years and then on top of that you can gain new patients through advertising, word of mouth, etc which will result in a NET gain. WIth ortho you're essentially losing a large chunk of your patients every four or five years when they get their braces off so you are essentially replenishing this deficit by NEEDING to attract new patients instead of using these new patients to GROW. Again I'm just going after this on a logical platform without seeing it happen in the "real world" so maybe Dr. Charlestweed would be so kind to offer his input as he is a practicing orthodontist and would thus have much greater insight that I would.

    3. GP not being a specialty is just plain semantics but okay "you got me" with that astute observation found in my original post. I define stable as being relatively resilient to a bad economy, having the most opportunities to practice and not having a field which is easily encroached upon (like Pedo which it seems like other than for reasons of behavior management do exactly what a GP does although maybe for reimbursement reasons they might do better in an identical situation)
     
  15. psiyung

    psiyung 1K Member

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    It has to be Oral Surgery. We're just scratching the surface with implants and the wide scope of hospital privileges they have make them (imo) the best long term stable profession. As far as finances I have a friend making $600k (net) 2 years out of residency. You do the math long term
     
  16. NileBDS

    NileBDS SDNator Moderator Emeritus

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    Yeah, I'm calling your bluff on that one. Curious, what state and city do you practice in (I'm assuming you're an OS?), and based on what facts exactly do you make such broad claims? Why anyone would choose to make such ignorant blanket statements is really beyond me. Words like "out-earning" and "a lot" and "on average" are merely smoke screens, stone-walling the whole discussion.


    Care to share some specific numbers/gross revenues for the past 3-4 years (duration of the recession)? I'm pretty sure the OP's question was related to "stability" during bad economic times (ie; resilience) and not earning potential or who makes more doing what. In other words, how has the recession affected your numbers?


    Leave it to SDN to turn such a simple discussion, into a pissing match between speacialty VS GP incomes.

    .
     
  17. NileBDS

    NileBDS SDNator Moderator Emeritus

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    Also incorrect. That is exactly what a GP does (and chooses not to do). They electively avoid making additional money by referring crappy cases (and crappy patients) out. It's not worth my time in most cases. We refer out difficult, and otherwise more profitable procedures, in exchange for a better lifestyle, better hours, lower risk, low-stress and more streamlined, clinically-predictable procedures.


    I would prefer to not; spend 3 visits on a necrotic root canal, or wait 6 months for my sinus lift to heal, or deal with the risk of fracturing someones jaw (perhaps even permanent parasthesia) for a couple of bony impactions, or care for medically compromised patients with 2 pages worth of current medications and allergies, or put my whole office on hold for a couple of hours performing tedious repetitive motions in someones tooth trying to negotiate a calcified or curved canal, or a broken file, or a whiny kicking and screaming kid with overprotective parents, or a gagger, or a relapsed ortho case, or waste my time and resources re-doing a sloughing perio graft on a royally pissed patient with exposed roots and sensitive teeth, or ... never mind. I think you get the point.


    .
     
  18. NileBDS

    NileBDS SDNator Moderator Emeritus

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    Short answer, based on my limited personal experience:

    Pedo
    General Practice
    Oral Surgery
    Everything else



    My rationale/observation: The comment pertaining to parents wanting to treat their kids before themselves is very true, and is the secret to most of pedo's job security. Most new families want kids, and (hopefully) will have parents wanting to care of them, and provide them with "better stuff/opportunities" then themselves. Another strong point not to be overlooked is the fact that patients can (and usually do) self-refer to pedo practices = traffic. Not so true for endo and perio, in contrast.


    GP is pretty self explanatory (good times - refer more, bad times - refer less).


    Oral surgery also has been pretty consistent over the years, in part due to the fact that most GP's are not risk takers (would still rather outsource high risk procedures to specialists - most of impacted molars are), find it cumbersome to set-up surgical suites in their office, and would just plain rather not deal with surgical complications. Added to that the fact that most patients prefer to have all 4 wizzies be removed one-shot (all 4 on a Friday morning), under some sort of sedation, and you can see how OS have themselves a nice cushy market niche.

    .
     
  19. NileBDS

    NileBDS SDNator Moderator Emeritus

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    The words "wide scope" and "oral surgeon" rarely come in one sentence, except of course in academic circles. No Oral Surgeon I know (I have about 5 referrals) does any "wide scope" procedures, and rarely (if at all) do anything at the hospital. No orthognathics, no trauma, no cancer, no mid-neck dissections, nor nerve repositioning, no jaw or facial reconstructions. Who are we kidding here. I'm not trying to bust your chops, but I just feel a responsibility to weigh in with my perspective as a recent dental student, now 4 years into private practice. The information which we have been spoon fed for years in school is most times very different from the reality on the ground.


    Oral surgeons have collectively allowed their profession to descend into the abyss known as highly re-reimbursable procedures and have overseen the dilution of their surgical turf/field down to wizzies and impants (procedures which can be taught to any 4th year dental student). What wide scope and what hospital privileges? Added to that, Oral Surgeons place some of the worst implants I've seen. I would send my cases to perio before I do an oral surgeon. PLUS, now endo residents wants in on implants too, so yeah ... I do not see oral surgery as maintaining any security in that department either. So now we're down to surgical extractions, which is still a pretty cushy niche. It's the truth man, I'm just calling it as it is for all these impressionable young grads. Trying to infuse some reality into this discussion.


    Let's also be honest here. The platform and audience here mostly consists of dental students and pre-dents, so let's get real. How many oral surgeons do you know, 2 years out of residency, making $600k? Because I personally and very well know a GP who takes home (net) $1.2-$1.5 million. From one practice. But how many of those are out there? The exception applies here, not the rule.

    .
     
    Last edited: 03.18.12
  20. psiyung

    psiyung 1K Member

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    Nile, I am a general dentist like yourself, so don't think that I am trying to bash any other specialty in any way. What I am saying is that with the type of training that they have, a lot of oral surgeons (especially those with an MD) will have the upper hand in a down economy. I take out partially impacted wisdom teeth myself at my practice, but I can hardly do it as efficiently as an oral surgeon. Yes, a dentist can get training in IV sedation, wisdom teeth removal, sinus lifts, and all that other good stuff, but in reality this is not the norm. Most gps will refer a lot of these headache cases out when they can prep 3-4 crown/bridge cases and become more efficient with their time. And there are a lot of OMSs out there that are bringing home above $400k a year. I have met ALOT of them (one experienced one is taking home close to a mill). Just think that your overhead is close to 40% and you do 3-4 full bony cases a day on average with IV sedation. Thats close to 8K a day just from extractions, not to mention implant placement and some other small out patient procedures they perform. And some of the best implants ive seen placed have come from an OMS that I refer my PPO patients to.
     
  21. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    The OMS residents (4 per year) coming out of my school for the past 2 years have all started above 400k as associates.
     
  22. El Salvaje

    El Salvaje

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    So what about the opportunity cost of starting so late in OMS? Many programs now have cut some of their more favorable loan options so that if you recieve any assistance whatsoever you would be accumulating interest throughout school. This means that the more time you are in school the more income you would NEED to offset your debt.

    Yes an OMS might make more than every other specialty taken at face value BUT how much of a hole did they dig themselves into given their far greater time spent in school making only a residents salary which is probably just enough to live on? I'd imagine that graduating at 30 and having to pile on the additional debt of buying into a practice, buying a car, supporting a family, etc wouldn't help either.

    Additionally, I have never extracted a 3rd molar or placed an implant (in fact I'm not even that far in school to know the steps involved) but it seems like there are more than a few dentists out there who just do there own after taking a few hands on courses. As we all know even though OMS does have a medical side, it is the dental side is the one which gives them such a cushy income/lifestyle. I'm thinking that this would actually DECREASE the stability of the OMS specialty given that if more GPs took courses to learn how to do these procedures competently then it would put a huge dent in their income potential.

    Again, I'm just speculating having no real world experience and would really appreciate the input of those of you who do. This forum is a great learning tool and I'm thankful to have practicing professionals to bounce these ideas off of.
     
  23. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    The debt they get into isn't really an issue. An absolute worst case scenario puts them at 600k debt... And when you're making 4-500k+ a year that is quickly paid down.

    I agree omfs is going to lose their stranglehold over implants...but bony extractions will still be handled by omfs primarily...and that will never go away. And there will always be some GPs who refer out for implants, and omfs will still get many referrals.

    They are the only specialty capable of deep sedation, and so will always get referrals for cases dealing with those cases.
     
  24. GTFOOMICT

    GTFOOMICT

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    Most of medicine is exactly how oral surgeons are. Broad training, but due to reimbursement, litigation, and efficiency, training does not match final scope. It's not a bad thing. Broad training gives the foundation for future advances.

    Besides, if even a small portion of oral surgeons practiced their full scope, there would be nothing in academic centers. And if there wasn't just one or two orthognathic guys in a major city, there would be 75 that do it once a year. What's better?

    That is my opinion after being exposed to academic medicine for 2 years.
     
  25. hifive

    hifive

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    Although not a specialty- Academia is very stable. Even in the worst of times schools will continuing producing dentists.
     
  26. yappy

    yappy

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    Is ortho really in as bad of shape as people suggest?
     
  27. DrJeff

    DrJeff Senior Member Moderator

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    Ummm, NO! The only "kickback" I get from the specialists that I refer to, is lets say that I have lunch 5 times a year with that specialist to discuss cases. The specialist will likly pick up the lunch tab 3 times while I only pick up the tab twice.

    In no way if I refer say a molar endo to my local endodontist do I get a check from the specialist for X%. Same with ortho, oral surgery, pedo, etc. And I'm not aware of any part of the country where the actual cash kick back happens. When a GP makes a referall to a specialist, its for multiple reasons. Most importantly it's because the GP feels that he/she can't effectively manage that patient themselves and also the the GP has 100% confidence in the ability of that specialist to effectively manage that patient. From a financial perspective, about the only thing that transpires is an occasional lunch or dinenr to discuss cases of mutual patients and maybe a year end, usually for the entire GP's office gift basket
     
  28. psiyung

    psiyung 1K Member

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    they may even throw in the occasional cookies or gift basket once or twice a year...
     
  29. DrJeff

    DrJeff Senior Member Moderator

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    And it's usually accompanied with a whole stack of referral slip pads which the staff of my office then quickly place in a prominent location in my operatories as they're devouring the baked goods and/or confections that are in that basket ;)

    To play on an old phrase, "the quickest way to a staff's adoration (and hence referral pad grabbing) is through their stomach :D " :laugh:
     
  30. Firm

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    GP is most stable because you can accumulate patients over the lifetime of the practice, where as most specialist are constantly trying to find new patients. The stability come in being able to get new patients while keeping the old ones. OS, Endo and Ortho ALWAYS need a fresh supply of new patients just to keep things going. The most stable specialties in order are:

    Oral Surgery (people will always need teeth pulled and they can be mobile)
    Pedo (There are not a lot and they can accumulate patients over the years)
    Pros (Super GP's. They have the ability to accumulate lots of patients and there aren't many.
    Endo (low overhead and the ability to be mobile increases the new patient potential)
    Ortho (Way too many. Not very mobile. GP's do a lot of there own ortho and they need a fresh supply of patients every 2 years)
    Perio (Most GP's are doing the hygiene, and OS compete for implants)
     
  31. ortho lurker

    ortho lurker

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    If it's absolutely just about the dinero, O.S. is probably the way to go and the 4 year track will suffice just fine. You hear about starting OMS associates who earn $400-500K their first year out and some make it a career traveling to different offices without having to start their own practice. A 4 year O.M.F.S. program is paid and is only 1 more year than a 3 year ortho residency.
     
  32. bikedoc

    bikedoc www.wiggleyourtooth.com

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    Interesting points.
     
  33. Firm

    Firm Member

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    There is a perfect storm of disaster going on in Ortho (and according to Levin perio too) right now:
    1.)Increasing number of orthodontists coming out of schools because the ortho programs make dental schools money.
    2.)Lowest number of children ages 9-15 in American history.
    3.)GP's and chains adding ortho to their services offered.

    This has put pressure on orthodontists to open more satellites which encroach upon other orthodontist's territory/bottom line creating a spiralling chain reaction of lower production, lower fees and higher overhead.
     
  34. 92CamaroLS1

    92CamaroLS1

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    I tend to go by the idea that if/when the zombie apocalypse happens... which skill would benefit me the most?

    OS
    General dentistry
    Bashing zombie brains

    OS was too much for me time wise and "Bashing Zombie Brains" isnt currently an ADA accredited specialty... so I stuck with general
     
  35. dort-ort

    dort-ort Dort-Ort

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    JUST 3 REASONS? off the top of my head I can think of 10 other reasons -- I list a few:

    4. old geezer orthodontists don't retire till their 120 yrs old.
    5. improvements in technique and technology allow each orthodontist to see double or triple the number of patients they normally would 10-15 years ago
    6. invisalign - means more gp's doing ortho
    7. six-month--(i'll leave you with an overbite and crossbite)--braces - means more gp's
    doing ortho
    8. economy forcing more gps to extend themselves to do ortho whether they can or not
    9. foreign trained ortho's coming into the country doing ortho as GP's
    10. increased not only the number of ortho programs but the number of residents at each programs are increased. If each program accepted 2-3 residents per year it would be fine if there were more programs but the programs are also accepting like 20 residents.
     
  36. SexyMariGal

    SexyMariGal

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    Hey Nile, just a curious question about your friend that nets over a million dollars a year as a GP from one office. Is this guy working 7 days a week, and possibly over 40 hours a week? It seems like that amount of production would require tons of time in the office, unless he has many associates working for him, but then wouldn't they be eating into his profit margin as well?

    Not sure how that relates to your previous statement about the better lifestyle and better hours as a GP, or even how netting a million dollars is even close to possible. Can you enlighten us a little on how such a practice, even though it is an exceptional case to the average, is even possible? Where is this doctor working that he can make such a massive amount of money? Is he only working 3 or 4 days and around 32 hours or less a week too? Sounds way too good to be true.
     
  37. Dgeorg6

    Dgeorg6

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    I'm pretty sure he was just saying that about the dentist to state a fact just because you know ONE guy making a ton of money, that doesn't make it the norm..

    As in when people are like "that average income is way to low, I know a guy who is making a million dollars!!", just because that one guy is making that much doesn't mean everyone is! Even though I'm sure their a quite a few OMFS making 500k+ and not so many dentist making 1 mill + but idk..
     
  38. sddat

    sddat

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    My opinion about all this...I went into dentistry to help people and to have a stable career. Honestly dentistry is stable and I think that there comes a time when you have to ask yourself what do I love to do? Put aside the stability and follow what you are passionate about. The different specialties are so varied. A periodontist and endodontist have completely different jobs day in and day out.

    I think they are all stable and if you feel like your business is slowing down, it would be time to continue your education and rethink what you're offering.
     

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