How much of a pay cut do you think we will see in the future...

Ill bite...

Dentistry, as with most any profession, undergoes swings in salaries and success in general. I feel that dentistry is on the downward swing for many reasons. Not a drastic, downturn that destroys careers etc, but enough of one that salaries will be depressed so that new graduates with crazy debts might have trouble paying off loans, or new dental offices in densely populated areas may close their doors. The reasons open for discussion are listed below:

1. Recession/"The New America": This recession has illuminated a problem in our workforce/economy. Before it was propped up by an overinflated construction industry that really kept the economy rolling. For instance, a booming construction industry keep banks flying high with mortgages, materials/manufacturing companies churning out products, and a lot of trickle down sectors flush with cash. This cash was passed along to employees who then spent money, some of which went towards dentistry. Now that the economy has normalized it is recognized that with technology more work can be done with less, companies are lean and mean, and the employed rates of 8-9% I fear will be around for a while until alternative industries arise, or manufacturing jobs return. With high unemployment, inflation, and lower wages that means less money for big money dental procedures and increased competition for what is remaining.

2. Increased number of dental graduates. Over the past few years many new schools have opened their doors and I believe 5-10 more are in the works for the next twenty years or so (Maine, Florida, NC, and others). This will put out an extra 1000-1500 students a year which will flood competitive areas and fill up lucrative "hot spots" once the word gets out. More dentists for the same patient pool (middle/upper class) will mean lower salaries, or higher fees to compensate.

3. High student debt. This will have a drastic impact on dentistry in the future. As more and more students attend the more expensive private schools that exist and are opening up (LECOM, Roseman, etc.) and emerge with 400K+ debt they will be desperate for a job to pay back the 950K+ in total debt with interest (with $4,000 per month repayments). They will then lower the demand for new graduates and jump into the growing corporate dental chains for assured salaries of 100K. Soon 100K becomes 80K becomes 60K as the chains do not have to compete for students, they simply crawl into the office begging for a job.

4. Corporate Dentistry: While I don't think they are bad for dentistry, they will lead to a lowering of salaries as mentioned above. The patient population they focus on is Medicaid and lower class incomes. As they move into rural/lower income areas they will impinge upon your mom/pop practices and take patients due to their lower fees.

5. Future technology: A single invention or vaccine could wipe out half of all dentists almost overnight. While I think this is unlikely to happen, it still could as there is a lot of money involved in dentistry (I think I read its a 5 billion dollar industry) and any innovation that takes a chunk of this money is good motivation to invent a golden bullet for the field.

What does this all mean? Well, lower salaries across the board for all graduates and current practitioners. Im pretty sure the "golden ages" of dentistry, or the peak spoke of earlier is over and we are headed down the mountain towards a valley of unknown depth. Just having a DMD/DDS and wielding a hand piece does not guarantee a 200K+ salary like 5 years ago. I shadowed two dentists that had a cosmetic/restorative practice that was making them 750K a year in profit! Then the recession hit and they almost lost the business until they retooled and now make according to them a paltry 180K a year. So what you are talking about how already taken place in the majority of offices. Most are down 10-15% from a few years ago. Since overhead stays about the same, that means 10-15% reduction in pay. That being said, a competent dentist with good personal skills will still be successful and make a great living. I think that in some ways it is good for dentistry as competition improves the level of service to the public.

Am I anti-dentistry? No...I love the field and it will always allow me to provide for my family. I left my previous job on my own accord to go back to school because I feel this profession is the best fit for my abilities and I really enjoy the practice of dentistry. Since the field is in flux, students should not go into the field for the money expecting a paved road to financial glory while working 30 hours a week. They will be in for a rude awakening and be very unhappy for their life.

Obviously I could be totally wrong and my post above is solely my opinion only...

Good luck to everyone and their dental journey!!

2012 wrote an excellent post above and I'd like to chime in to offer my opinions.

1. Recessions occurs every 10 to 15 years on various scales. As the world economy gets more sophisticated, the swings occur much harder and affect significantly more people. However, with that statement the economy is slowly starting to improve and will be for better or worse when most predents on this board finish d-school. While patients may be frugal and cut back on some non-essential dental services i.e. cosmetic procedures, they can't avoid the basic and necessary services. So what does that mean? Less revenue but there is a bottom to how much patients will cut back and essential services will still fund a a feasible 120 to 150K salary for any dentist.

2. While there is an increase in the number of new dental schools opening their doors, there might be schools that will close due to lack of funding or low profitability. Additionally, there are more dentists who will retire in the next 10 to 15 years, then there are freshly minted dentists. What we might see is a balance where the old dentists are replaced by the new dentists from older schools + new dentists from newer schools. This will effectively create a no "net new" dentists in the field. This is evidenced by BLS and ADA data with states that for every 3 dentists who retire, only 2 new dentists enter the field.

3. Debt is a scary thing and predents want to avoid debt like the plague. Yes you will incur more debt but thats the risk one takes with this profession. If debt is the only problem there are multiple solutions like going to the cheapest in-state school or borrowing money from your parents via a Home Equity loan for a significantly cheaper interest rate than any govt or private loans can offer. Additionally you have to factor in living costs and live style choices, if those are managed then 200 to 250K worth of debt will be manageable. The only other resort is to seek a debt free career like accounting, PA or nursing.

4. Corporate medicine/dentistry and future tech are interesting subjects that affect nearly every field of medicine. As students or practitioners we can't change these aspects and we simply have to live with them.

Now the last piece of advice I'd like to offer is to look on the bright side. I hate hate hate the "sky is falling" mentality. Dentistry like all other professions has to be analyzed via a total career outlook. Its not all about money because if you want a simple risk free way to make a good living you should look at accounting but then you realize that the perks of an accountant don't quite add up to the perks of a dentist.

Being your own boss, setting your own hours, getting paid for nearly every procedure or minute spent at your office and having the flexibility to work in a profession that is essentially recession proof (meaning no long term unemployment or loss of total income) are some of the main reasons I chose dentistry. Like 2012 I come from another field that by comparison to dentistry was risk free, I'm also debt free and will be throwing myself down the debt rabbit hole. However, I want to elaborate the fact that nothing that's good in life is easy nor is it fun, but ultimately I can see myself much happier in a riskier profession like dentistry than in a typical 9 to 5 career where no job security exists, benefits and hours suck and I have to answer to annoying bosses and corporate trolls. And last of all, I understand that as a dentist my income is virtually limitless, I can work 50 to 100 hours a week, but as a corporate employee I dont earn one penny in overtime nor am I guaranteed any additional income if I work over the standard 40 to 45 hours a week.

I implore all predents to look at the whole picture and not to make rash decisions based on a few facts. Only after we analyze the entire situation can we make any rationally cohesive decisions.

Good luck.

Took me forever to find this article.. I only read between 300 to 400 articles a day. Expect contentious relationship between labor and management, with management taking a hard line attitude toward labor in this decade.
Caterpillar Locks Out Workers in Canada
http://www.nytimes.com/2012/01/03/b...erpillar-locomotive-plant-in-canada.html?_r=1

OTTAWA — A lockout late Sunday of about 465 workers at a Canadian locomotive factory owned by a Caterpillar unit has renewed debate in Canada about the labor impact of foreign ownership.

The action came after the employees in London, Ontario, rejected a contract proposed by Electro-Motive Canada. The Canadian Auto Workers union said the proposal would cut wages in half, substantially reduce benefits and end the current pension plan.

“It’s not really a proposal, it’s an ultimatum,” said Tim Carrie, president of the union local that represents the factory’s workers. “This is an attack on middle-class jobs.”

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Not much disposable income left for dental care once management ask you to take a 50 % pay cut.

But some of the union’s executive members have suggested that Caterpillar’s contract demands were intended to provoke a shutdown of the Canadian factory as a prelude to moving all production to the United States.

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How Ironic !!

Moral of the story: Money may or may not be there in the future. If you decide go into dentistry, do it for the right reason..

Here is another article from Wall Street Journal...
Caterpillar, Rio Initiate Lockouts in Canada
http://online.wsj.com/article/SB10001424052970203550304577136533843111036.html

Union officials said Caterpillar's latest proposal would halve wages and reduce benefits. Tim Carrie, president of the CAW's local branch, said the cut would reduce hourly pay to 16.50 Canadian dollars (US$16.16) for most workers from C$34.

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Soros Says World Economy Facing 'Vicious' Deflationary Cycle
http://online.wsj.com/article/SB10001424052970204257504577150403662707094.html?mod=googlenews_wsj

BANGALORE – George Soros, the billionaire U.S. investor, said Monday the global economy is facing a "vicious" deflationary cycle as members of the euro zone cut back sharply on spending to bring their budget deficits under control, crimping demand and squeezing prices.
The euro zone faces a period of "draconian austerity" as a result ...

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For the record; we're not in a recession. We left that back in 09 - we've had positive GDP growth ever since. As the dust settles they're finding that more GDP growth had occured since than previously thought.

But I do agree - it's not like it's 2004 anymore.

wow - good post yunowu. My experience has been pretty negative as a wage earner who had to rely on the decisions of a "boss". I would rather work 80 hrs a week for myself than 40 for someone else.

yappy said:

For the record; we're not in a recession. We left that back in 09 - we've had positive GDP growth ever since. As the dust settles they're finding that more GDP growth had occured since than previously thought.

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And since 2009, the national deficit has increased from 11 trillion to 15 trillion dollars. And to reduce such massive deficit, we, our children, and our grand children will have to pay higher taxes in the future. California sale tax used to be about 7% ten years ago. Now, it is 10%….and the state is still broke. More money go to the government, less money will be available for people to spend on fixing their teeth.

yappy said:

My experience has been pretty negative as a wage earner who had to rely on the decisions of a "boss". I would rather work 80 hrs a week for myself than 40 for someone else.

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I’ve worked for the dental chain for more than 10 years. I’ve met a lot of associate dentists who sold their private practices and went back to work for the dental chains. Sometimes, running your own office is more stressful as working for someone else. There is no guarantee that you will make more when you have your own practice. My wife would rather travels to different GP offices to place implant for them than working at her own office…..more $$$, shorter work hours, fewer emgergency calls, and less stress.

I think you and I can both agree that instead of taxing people in the future to close a deficite there should be large reforms in the size and scope of the government. Indeed, in the last few years public sector employees are seeing more layoffs and less growth than the privite sector. But that is a discussion for another thread.

You make great points about working for a corp. My experiences working has been as a non-dentist. Maybe working for someone else as a contractor or a highly valued employee is different than what I did. I guess the biggest difference is that dentists have a marketable skill and I was a low skill vet lol.

charlestweed said:

And since 2009, the national deficit has increased from 11 trillion to 15 trillion dollars. And to reduce such massive deficit, we, our children, and our grand children will have to pay higher taxes in the future. California sale tax used to be about 7% ten years ago. Now, it is 10%….and the state is still broke. More money go to the government, less money will be available for people to spend on fixing their teeth.


I've worked for the dental chain for more than 10 years. I've met a lot of associate dentists who sold their private practices and went back to work for the dental chains. Sometimes, running your own office is more stressful as working for someone else. There is no guarantee that you will make more when you have your own practice. My wife would rather travels to different GP offices to place implant for them than working at her own office…..more $$$, shorter work hours, fewer emgergency calls, and less stress.

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For reasons that are beyond the scope of this discussion it is very likely that globally economies will see major downturns over the next few decades, far greater than the recent recession. Across the world countries are leveraged with an unprecedented amount of debt, and accumulation of debt has grown exponentially and greatly outpaced economic growth. In terms of the future in the United States, healthcare will be by far the largest contributor to the debt as costs, utilization and government spending on healthcare are all rising rapidly. Current physician and dentist salaries are unsustainable in the long term, and we are already seeing some pay cuts taking place. For physicians medicare is becoming an increasing portion of overall reimbursement as baby boomers retire, and there are already major cuts to medicare on the horizon including the oft-postponed but inevitable SGR implementation which currently is set to reduce reimbursements by 27%. Dentists are less reliant on government spending, but similar cuts are in store for them too. I have two family members who are dentists in Washington, where 25% of the population is insured by Washington Dental Service, who recently cut their reimbursements by 15%.

Compensation of health care professionals can only be as high as patients incomes can sustain, and given that our current rate of economic growth fueled by debt accumulation is unsustainable, it is likely that nationwide standard's of living will plummet when we are forced to realize that all Americans need to live below our means to repay the bill from living beyond our means for so many years.

Agreed. Lets hope some boy genius will create a new field of business that will rocket the US into financial bliss. One important point though is that Gen X + Gen Y is larger than the baby boomer generation.

LieutenantDan said:

For reasons that are beyond the scope of this discussion it is very likely that globally economies will see major downturns over the next few decades, far greater than the recent recession. Across the world countries are leveraged with an unprecedented amount of debt, and accumulation of debt has grown exponentially and greatly outpaced economic growth. In terms of the future in the United States, healthcare will be by far the largest contributor to the debt as costs, utilization and government spending on healthcare are all rising rapidly. Current physician and dentist salaries are unsustainable in the long term, and we are already seeing some pay cuts taking place. For physicians medicare is becoming an increasing portion of overall reimbursement as baby boomers retire, and there are already major cuts to medicare on the horizon including the oft-postponed but inevitable SGR implementation which currently is set to reduce reimbursements by 27%. Dentists are less reliant on government spending, but similar cuts are in store for them too. I have two family members who are dentists in Washington, where 25% of the population is insured by Washington Dental Service, who recently cut their reimbursements by 15%.

Compensation of health care professionals can only be as high as patients incomes can sustain, and given that our current rate of economic growth fueled by debt accumulation is unsustainable, it is likely that nationwide standard's of living will plummet when we are forced to realize that all Americans need to live below our means to repay the bill from living beyond our means for so many years.

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Some areas of the country may very well see greater hits in dentist's incomes than others. Other areas, the areas that for some reason many dental students/dentists may think are "undesireable" to live in (and by no means am I just talking about inner city, poor areas) are very lucrative, greatly underserved markets where it is quite reasonable to expect that at worst a dentist's income will remain the same, and in many cases, increase over the coming years.

love it!

Before we all start saying the sky is falling on dentistry, remember that the economy affects all jobs (unless you work on Wall Street having the ability to make more money while others lose it at the same time producing nothing at all). Going to law school, getting into 200k debt, and getting a job at 30k a year if that is worse than dentistry. Going to medical school with the same debt with decreasing salaries isn't a great situation. With many white-collar jobs offering lowering salaries with increasing debt there might be more drops in the housing market. Markets have a way of stabilizing to meet the general condition of the economy, and this economy will likely reflect that of the current state of the country.

CaliDDS1986 said:

Before we all start saying the sky is falling on dentistry, remember that the economy affects all jobs (unless you work on Wall Street having the ability to make more money while others lose it at the same time producing nothing at all). Going to law school, getting into 200k debt, and getting a job at 30k a year if that is worse than dentistry. Going to medical school with the same debt with decreasing salaries isn't a great situation. With many white-collar jobs offering lowering salaries with increasing debt there might be more drops in the housing market. Markets have a way of stabilizing to meet the general condition of the economy, and this economy will likely reflect that of the current state of the country.

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+1 IMO the only other good or better field than dentistry is PA. My friend in CT works 3 days a week and makes 100K but he's not his boss, does not earn overtime and is the doctor's biatch.

I think you can add physician to that list if one doesnt mind post grad training. It is not uncommon for non-primary care docs to make good money and have decent lifestyles.

wired202808 said:

+1 IMO the only other good or better field than dentistry is PA. My friend in CT works 3 days a week and makes 100K but he's not his boss, does not earn overtime and is the doctor's biatch.

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yappy said:

I think you can add physician to that list if one doesnt mind post grad training. It is not uncommon for non-primary care docs to make good money and have decent lifestyles.

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MDs make a ton but the amount of years spent in school + tuition is not better than being a PA. The guy who I mentioned in the previous example went to a 2 yr program and spent like 60K on it and is now making bank. Compare him to an MD who would spend an additional 4 years in residency making about 55K a year and having about 250 or 300K in loans. Eventually the MD will "out-earn" the PA but it wont happen for 10 to 15 years and by that time the PA can save or invest that money and be very well off.

MD just doesnt pay, plus there are weekends you have to be on call, you get f**ed by the HMOs and you risk getting sued via phony malpractice suits. 10 to 15 yrs ago MD was the ish, but I think in the last 5 years PAs really prove how successful their programs have become and how much they're gonna grow over the next 10 to 20 yrs.

to each their own. If I were a woman I would do PA for sure. Less stress and less debt guilt for starting a family.

wired202808 said:

MDs make a ton but the amount of years spent in school + tuition is not better than being a PA. The guy who I mentioned in the previous example went to a 2 yr program and spent like 60K on it and is now making bank. Compare him to an MD who would spend an additional 4 years in residency making about 55K a year and having about 250 or 300K in loans. Eventually the MD will "out-earn" the PA but it wont happen for 10 to 15 years and by that time the PA can save or invest that money and be very well off.

MD just doesnt pay, plus there are weekends you have to be on call, you get f**ed by the HMOs and you risk getting sued via phony malpractice suits. 10 to 15 yrs ago MD was the ish, but I think in the last 5 years PAs really prove how successful their programs have become and how much they're gonna grow over the next 10 to 20 yrs.

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wired202808 said:

MDs make a ton but the amount of years spent in school + tuition is not better than being a PA. The guy who I mentioned in the previous example went to a 2 yr program and spent like 60K on it and is now making bank. Compare him to an MD who would spend an additional 4 years in residency making about 55K a year and having about 250 or 300K in loans. Eventually the MD will "out-earn" the PA but it wont happen for 10 to 15 years and by that time the PA can save or invest that money and be very well off.

MD just doesnt pay, plus there are weekends you have to be on call, you get f**ed by the HMOs and you risk getting sued via phony malpractice suits. 10 to 15 yrs ago MD was the ish, but I think in the last 5 years PAs really prove how successful their programs have become and how much they're gonna grow over the next 10 to 20 yrs.

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While being a PA is a pretty good career choice, i don't think that making 100K is the norm. I know it does happen, but from a couple of PA friends i have heard more like 80K is more normal, depending on your specialty. Also, i have heard it is somewhat difficult to find a job right after graduation. Again, this is just what i have heard... no conclusive evidence, although BLS says avg = 82K, just not sure if it is representative of the profession.

I think PA wins over any primary care MD, but almost every med specialty outside of primary care is going to be making 250-400K. In which case they will catch a PA very quickly.

MD specialists will out earn PAs almost immediately.

Anesthesiologists start at about 275k. They could pay 5k a month into their student loans and pay them off in 5-6 years and still be making more than double your better paid PAs. Stop spreading your garbage.

DavesNotHere said:

MD specialists will out earn PAs almost immediately.

Anesthesiologists start at about 275k. They could pay 5k a month into their student loans and pay them off in 5-6 years and still be making more than double your better paid PAs. Stop spreading your garbage.

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I think Wired was referring to primary care physicians, not specialists.

DavesNotHere said:

MD specialists will out earn PAs almost immediately.

Anesthesiologists start at about 275k. They could pay 5k a month into their student loans and pay them off in 5-6 years and still be making more than double your better paid PAs. Stop spreading your garbage.

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Again I was referring to regular general specialties and a few others like pediatrics, etc. Also if you want to talk about garbage then you should probably mention that only a small % of all MD students make it into the Anesthesiology program and they still spend 4 years in a residency while a PA makes real money. I'm not arguing whos going to make the most amount of money, but a PA has a much better end of the stick: they're not on call, they spend less time in school, they earn money faster and they have a lot less stress than an MD.

Oh and unlike Anesthesiologist a PA doesn't have to stress about a patient dying.

UltimateHombre said:

While being a PA is a pretty good career choice, i don't think that making 100K is the norm. I know it does happen, but from a couple of PA friends i have heard more like 80K is more normal, depending on your specialty. Also, i have heard it is somewhat difficult to find a job right after graduation. Again, this is just what i have heard... no conclusive evidence, although BLS says avg = 82K, just not sure if it is representative of the profession.

I think PA wins over any primary care MD, but almost every med specialty outside of primary care is going to be making 250-400K. In which case they will catch a PA very quickly.

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An average of 82k implies that regions such as NJ, CT, some in NY and the West coast will make a lot more. My friend is not the norm since most people dont earn his kind of money for 3 days a week, but my other friends who practice in NY still make close to his type of money while working full time. Additionally, its easy to find a job as a PA because the demand is increasing esp in big cities like NY, again I can't speak for the rest of the country.

While its obvious that big specialties will earn more over the long period of time, PAs have it pretty sweet. a PA will spend 2 years in school and then go to work and make $$$ right away meanwhile an MD will spend 4 yrs in med school + 4 years specializing. That's 6 more years to make extra $$$. If you think about it PAs will earn a decent living even when compared against Dentists. They won't have to deal with the debt and they'll spend those extra 3 years working while we're still in school and doing our residencies.

I'm not interested in that type of profession and I want to be my own boss that's why I went the DDS route, but ultimately a PA is a great profession to earn 100K and go home and sleep easy at the end of the night. Also the last thing I wanted to mention 400K is a very high number for most MDs even hospitals in NY tend to pay around 250 to 300 for the high high high end specialities. I think an average MD can expect 200 to 250, anything above that requires exceptionally long hours.

wired202808 said:

Again I was referring to regular general specialties and a few others like pediatrics, etc. Also if you want to talk about garbage then you should probably mention that only a small % of all MD students make it into the Anesthesiology program and they still spend 4 years in a residency while a PA makes real money. I'm not arguing whos going to make the most amount of money, but a PA has a much better end of the stick: they're not on call, they spend less time in school, they earn money faster and they have a lot less stress than an MD.

Oh and unlike Anesthesiologist a PA doesn't have to stress about a patient dying.

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General specialties?

I guess i dont like that youre obviously stating an opinion so resolutely.

MGMA reports that specialists earn ~350k on average. With PA you need a 4 year degree + premed reqs + allied health cert (1-2 yrs) + 2k hours experience (2 yrs or MORE) + 2-3 yrs of PA school.

2 years hardly.

wired202808 said:

An average of 82k implies that regions such as NJ, CT, some in NY and the West coast will make a lot more. My friend is not the norm since most people dont earn his kind of money for 3 days a week, but my other friends who practice in NY still make close to his type of money while working full time. Additionally, its easy to find a job as a PA because the demand is increasing esp in big cities like NY, again I can't speak for the rest of the country.

While its obvious that big specialties will earn more over the long period of time, PAs have it pretty sweet. a PA will spend 2 years in school and then go to work and make $$$ right away meanwhile an MD will spend 4 yrs in med school + 4 years specializing. That's 6 more years to make extra $$$. If you think about it PAs will earn a decent living even when compared against Dentists. They won't have to deal with the debt and they'll spend those extra 3 years working while we're still in school and doing our residencies.

I'm not interested in that type of profession and I want to be my own boss that's why I went the DDS route, but ultimately a PA is a great profession to earn 100K and go home and sleep easy at the end of the night. Also the last thing I wanted to mention 400K is a very high number for most MDs even hospitals in NY tend to pay around 250 to 300 for the high high high end specialities. I think an average MD can expect 200 to 250, anything above that requires exceptionally long hours.

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DavesNotHere said:

General specialties?

I guess i dont like that youre obviously stating an opinion so resolutely.

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Of course its my opinion. Yes i'm referring to the non-competitive specialties that dont pay out as much such as Peditrician. Also dont forget that the 250K you pay out in loans is money that's coming out of your pocket when other professions like PAs dont have as much debt. So when you wrap up your residency they have more $$$ in the bank before you, yes you'll exceed them soon enough but what I'm saying is that as a whole 8 years of med schools + residency is a lot of work vs. 2 yrs in PA school and then go earn that 100K. Obv doctors are paid more but is 250K a year with being on call, increased stress, higher malpractice suits and potential of patients dying worth more than a PA program? Maybe to some, but not to others.

Additionally an MD will work more than 40 hours a week so per hour an MD will make a significantly smaller amount. Meanwhile a PA can do their 9 to 5 and go home with a good pay check.

My cousin is a MD anesthesiologist. The hospitals he works for pay him very little and some hospitals don’t pay him at all. Unlike the surgeon who gets paid a salary from the hospital, my cousin gets paid by billing the patients’ insurance. He has to hire a biller to do this for him. When he treats an illegal immigrant who has no insurance, he pretty much works for free....and unlike dentistry, he can’t deny the patient when the patient has no insurance. He works 40+ hours a week. The worst part about his job is when he has to sleep in the hospital away from his wife and kids. Until now, he still has not done paying off his student loans. He still lives in rural Riverside county area (in California) because he can’t afford to buy a house in Orange County.

I used to idolize my cousin because he is so smart. I studied 100 times more than him and my GPA and MCAT score were still lower than his. I regarded myself as a failure when I got accepted to dental school…. and my cousin got accepted to med school. Now, comparing my cousin’s lifestyle to mine, I am glad that I picked dentistry. If I were smart like my cousin, I would be a physician and work like a dog at some hospitals. My cousin even told me that if he knew anesthesiology was like this, he would have picked dentistry instead of medicine. A co-resident of his hated anesthesiology so much that he decided to quit his job and switched to pain management.

Such an interesting and important question.

Do you see the common thread here?

If something can be commoditized, the cost and value of it "race to the bottom" and whatever product or service is being provided is cheapened. If a product or service is unique, engaging, irreplaceable, scarce- then it cannot be commoditized and the people who provide it cannot be cheapened.

For instance: you can get digital recordings of music for $0.99 on iTunes. You can get it for free in many ways. Want to see the musicians in concert, live, face-to-face? You're gonna pay. The one form of their music is a commodity, and the unit cost of reproduction and distribution of any digital information approaches zero over time. The concert is decidedly NOT a commodity. There are only so many seats, only so many nights in an year available for them to perform. The experience is scarce, and therefore valuable.

For some reason, our medical colleagues have made the provision of health care into a System and have, at least in some instances, commoditized what they do. For reasons that I do not fully understand even though I'm a dentist, we in dentistry have not done that, unless we are talking about a chain that has made the decision to base their business model on lowest cost. Then, again, they are racing to the bottom and have let themselves become a commodity.

More here if interested: http://en.wikipedia.org/wiki/Bertrand_competition

So to answer your question: we will take no pay cut. Unless we allow ourselves to be commoditized, then we will take a major pay cut!

On the negative side: loans. When I graduated I faced terrible interest rates and Congress took away the ability to deduct the interest on student loans. Now interest rates are low and you can deduct again, but the raw number is terrible. Awe-inspiringly frightening.

That's the only bad news.

Before the economic downturn, we were graduating 4,000 dentists a year and losing 6,000 to retirement. Out of 166,000 total, incuding military and institutional. WITH a growing U.S. population. Job security! And, unfortunately, this is a population that takes in more refined carbohydrates more frequently than any in human history. I could be a busy dentist without any cavities occurring; they occur all the time though, and drive me crazy. Mark my words- if there were a caries vaccine or another preventive treatment tomorrow, we'd still be busy. And more than that, human nature being what it is, people would STILL get their frakking cavities. Any system can be overloaded.

We have the coolest greatest technology ever. We can do more for our patients than ever before. Here's some of what we've got going on right now in our office, the very best tech by far being the surgical operating microscope: http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2011/03/light.html

More than even any of that, we need to make ourselves indispensible. To our pateints, to our communities, to our staff. Here's how you avoid being a commodity:
1- Delight people.
2- Solve their problems for them. The more interesting, the better.
3- Or both.

Courtesy of Seth Godin. I'll close with an excerpt from his amazing book Linchpin:

Well, ok, TWO excerpts:

The essence of mass production is that every part is interchangeable. Time, space, men, motion, money, and material—each was made more efficient because every piece was predictable and separate. Ford's discipline was to avoid short-term gains in exchange for always seeking the interchangeable, always standardizing. It only follows, then, that as you eliminate the skilled worker, the finisher, the custom-part maker, then you also save money on wages as you build a company that's easy to scale. In other words, first you have interchangeable parts, then you have interchangeable workers. By 1925, the die was cast. The goal was to hire the lowest-skilled laborer possible, at the lowest possible wage. To do anything else was financial suicide. That's the labor market we were trained for.

"In other words, first you have interchangeable parts, then you have interchangeable workers." Dang. Da-aaang! I think about this on some level each and every day. I continually figure out ways in which I, and my staff, and even my patients can keep avoiding this terrible fate. Yes, patients too. They don't know it yet but they really appreciate when we point out their potential to them. Point out someone's potential- all it takes is a word or two of encouragement, nothing hard or drawn out- and their ties to you become stronger. It's much more difficult to treat someone (you) as a commodity if you've pointed out their potential to them from time to time.

We can't profitably get more average.
We can't get more homogenized, more obedient, or cheaper. We can't get faster, either.
We've gone against our true nature and corporatized, anonymized, and dehumanized as many of our systems as we possibly can. Even health care is a system now, not a human interaction. We could probably go even further, actually, but I'm betting it won't be a fun or profitable journey.
If all mortgages are the same, of course they can be chopped up and remixed and resold. But that means all bankers and all homes are the same, and so are all homeowners. Which means the cheap ones or the profitable ones are all that matter.
If all online products at all online stores are the same, then of course I'll use a price-shopping Web site to find the cheapest product.
If all employees are nothing but a résumé, and résumés can be scanned, then why are we surprised that our computers end up finding us anonymous average people to fill our anonymous average jobs?
If every restaurant on the highway will give me precisely the same cheery service from the same robotic staff, at the same prices, then why does it matter where I stop?
Do we need to be flatter and smaller?
It's our desire to be treated like individuals that will end this cycle. Our passion for contribution and possibility, the passion we've drowned out in school and in the corporate world—that's the only way out.
Every successful organization is built around people. Humans who do art. People who interact with other people. Men and women who don't merely shuffle money, but interact, give gifts, and connect.
All these interactions are art. Art isn't only a painting; it's anything that changes someone for the better, any nonanonymous interaction that leads to a human (not simply a commercial) conclusion.

Great points. I see both medicine and dentistry being increasingly commoditized in the future. This can be done via mid levels, corp entities, and an overall effort to standardize care (cook book) and allow technology to make technical tasks easier so less-trained people can do the same job for less money.

This is true in every other field too though. The only thing that is resistant to becoming commoditized (IMO) is management. They, who destroy most other professions via the mechanisms listed above, will never allow themselves be comoditized.

charlestweed said:

My cousin is a MD anesthesiologist. The hospitals he works for pay him very little and some hospitals don’t pay him at all. Unlike the surgeon who gets paid a salary from the hospital, my cousin gets paid by billing the patients’ insurance. He has to hire a biller to do this for him. When he treats an illegal immigrant who has no insurance, he pretty much works for free....and unlike dentistry, he can’t deny the patient when the patient has no insurance. He works 40+ hours a week. The worst part about his job is when he has to sleep in the hospital away from his wife and kids. Until now, he still has not done paying off his student loans. He still lives in rural Riverside county area (in California) because he can’t afford to buy a house in Orange County.

I used to idolize my cousin because he is so smart. I studied 100 times more than him and my GPA and MCAT score were still lower than his. I regarded myself as a failure when I got accepted to dental school…. and my cousin got accepted to med school. Now, comparing my cousin’s lifestyle to mine, I am glad that I picked dentistry. If I were smart like my cousin, I would be a physician and work like a dog at some hospitals. My cousin even told me that if he knew anesthesiology was like this, he would have picked dentistry instead of medicine. A co-resident of his hated anesthesiology so much that he decided to quit his job and switched to pain management.

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Sounds like ur cousin should just work at a different hospital...the average income for anesthesiologists is well over 300k

DavesNotHere said:

Sounds like ur cousin should just work at a different hospital...the average income for anesthesiologists is well over 300k

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My cousin has been an anesthesiologist for 10+ years. He has tried different hospitals throughout Southern California and they are pretty much the same….patients who has no insurance, HMO, and medicaid. Just last week, he got called in at 2 AM to perform an epidural and that patient has medicaid (which only pays him $200). After that epidural procedure, he drove home, took a quick shower, and got ready to work at 7AM. That's not the kind of lifestyle I want to have.

Last month, I invited my cousin to come my son's birthday party on a Sunday. He joked: "I am on call that day but I can still come and the earliest time I can be at your house is 6 AM Monday."

all of the points you described are the strong reasons why i decided to go to dental school. being a doctor isn't worth it anymore. people have to really love what they are doing in medicine to put up with the bs that they take.

On the subject, here are some great points as to how to avoid the commoditization of your practice:

http://www.dentalmarketingsucks.com/blog

Most of points that I've been trying to make is that medicine is not nearly as bad a gig as many say it to be. It's almost like we're trying to reduce cognitive dissonance by bashing medicine. Each field has their challenges and pit falls but I dont think it's as black and white to a non-bias observer. I think dentistry is a great field on its own.

yappy said:

Most of points that I've been trying to make is that medicine is not nearly as bad a gig as many say it to be. It's almost like we're trying to reduce cognitive dissonance by bashing medicine. For example - I too have a physician faimly member. He is a Emergency physician who makes 410k working 38 hours a week. He did three years of residency and has paid all his student loans (120k) off after 5 years of practice.

If you comapair his situation to say, an orthodontist who has way more student loans and had to actually PAY for residency, it seems hard to make the case there is some huge divide between medicine and dentistry in terms of finances.

Also, the lastest MGMA says the median anesthesiologist makes 350k (~60k more than the average orthodontist according to the ADA) with the upper 75% being ~500k. I guess CA is a bad area for medicine too.

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I'm sure your family member doctor is doing great. The thing is, tuition/debt has skyrocketed since his day and it's becoming unreasonable to pursue certain fields in medicine/dentistry unless you have a game plan for the end. Most residencies will pay you btw. If you choose a residency in which you pay for the education, then that's also your choice. I think your also forgetting the fact that physicians, especially anesthesiologists, have crazy high malpractice insurance that they have to pay and if someone dies, you're doomed. So in all consideration, it's not about how much you make in the end. Many dentists work great hours, make good money, very low malpractice, lots of autonomy, and are not on call ;]

charlestweed said:

My cousin has been an anesthesiologist for 10+ years. He has tried different hospitals throughout Southern California and they are pretty much the same….patients who has no insurance, HMO, and medicaid. Just last week, he got called in at 2 AM to perform an epidural and that patient has medicaid (which only pays him $200). After that epidural procedure, he drove home, took a quick shower, and got ready to work at 7AM. That’s not the kind of lifestyle I want to have.

Last month, I invited my cousin to come my son’s birthday party on a Sunday. He joked: “I am on call that day but I can still come and the earliest time I can be at your house is 6 AM Monday.”

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Maybe it's SoCal then. I'm in a GPR now in the midwest, and the gas guys work long hours (55 or so a week...comparable to the other docs) but they start at 280 but after 10 years theyre at 400k no problem. Call is call i'll agree, but to make that kinda money to play on ur ipad seems good to me. I wont disagree that ortho is a good gig too

I actually forgot two other things that are relevant.

One is that some people assert that dental insurance is going to just go away in time. It's really not "insurance", it's a benefit that offsets costs. And in the contact sport that is health care policy today, many employers are being so squeezed by the rising cost of medical insurance that they are going to negotiate away the dental part just to save that last dollar or two.

This of course would work in our favor. But whether it happens or not, we can fight back right now. Like several practices around the country, we created our own insurance for patients. It's not really "insurance" either but it rewards people for compliance and for coming to our practice. Preventive and diagnostic care is all "covered" when they pay a yearly fee, which costs less than if they just came in. And most procedures are reduced 20%, with 10% on implants and Invisalign due to our higher outside costs. I can go into more detail if anyone wants. This is mainly intended for new patients but our existing patients are welcome to subscribe as well. And people love it, they just love it.

Then there is the inescapable fact that when people delay necessary dental treatment, it only gets worse, more painful (physically and esthetically), and more expensive. It's a shame but there is no escaping it. Rather than re-write everything allow me to link to a post I did on it:

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2010/12/dental-economics-101-from-the-patients-standpoint.html

I write for patient's viewpoint so it's elementary but these are important things for us to be thinking about.

The upshot is, we're all just about to get really really busy. After all, the economy tanked in 2008, things have been building in the mouths of the non-compliant especially in terms of caries and its effects. Still, my practice and many thousands of others are busy already because we aren't part of a vast corporate system and we have not commoditized people. That is, and always will be, dentistry's great advantage. And so my view is- no pay cut at all.

DavesNotHere said:

Maybe it's SoCal then. I'm in a GPR now in the midwest, and the gas guys work long hours (55 or so a week...comparable to the other docs) but they start at 280 but after 10 years theyre at 400k no problem. Call is call i'll agree, but to make that kinda money to play on ur ipad seems good to me. I wont disagree that ortho is a good gig too

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Yeah, things are tough here in CA. My cousin never tells me how much he makes but I am sure it is probably over $200k/year, which is not much if you work long hours, are on call all the time, have $200k student loans, and live in California (where the avg home price is $500-600k). All I hear from my cousin is the constant whining about his job and how his salary is declining due to the tough economy (I always thought that medicine is the only profession that is not affected by the recession)….fewer surgeries mean fewer anesthesia cases for him.

My cousin did a couple of IV sedation on my wife’s patients at her perio office and that when he realized how awesome dentistry is…..good pay, great hours, autonomy, no hospital bureaucracy bs. He wished he could turn back the clock so he could apply for dental school instead of med school.

Maybe you and your wife can hook your cousin up by connecting him with many dentists - making him the defacto-full time-dental anesthesiolgist (@ 4 days / wk).

health care is an interesting industry... I was hearing some dentists kick around production numbers the other day while shadowing at a multidecipline practice and to many people it would sound fantastic; however, I think that the student loans and educational grind changes people. But lay people have no compassion. I cant tell you how many people I know who think both physicians and dentists are way over paid.

charlestweed said:

Yeah, things are tough here in CA. My cousin never tells me how much he makes but I am sure it is probably over $200k/year, which is not much if you work long hours, are on call all the time, have $200k student loans, and live in California (where the avg home price is $500-600k). All I hear from my cousin is the constant whining about his job and how his salary is declining due to the tough economy (I always thought that medicine is the only profession that is not affected by the recession)….fewer surgeries mean fewer anesthesia cases for him.

My cousin did a couple of IV sedation on my wife's patients at her perio office and that when he realized how awesome dentistry is…..good pay, great hours, autonomy, no hospital bureaucracy bs. He wished he could turn back the clock so he could apply for dental school instead of med school.

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yappy said:

Maybe you and your wife can hook your cousin up by connecting him with many dentists - making him the defacto-full time-dental anesthesiolgist (@ 4 days / wk).

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i dont like this one bit...but im biased

DentinBond said:

If something can be commoditized, the cost and value of it "race to the bottom" and whatever product or service is being provided is cheapened. If a product or service is unique, engaging, irreplaceable, scarce- then it cannot be commoditized and the people who provide it cannot be cheapened.

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This is so true. Speaking of Anesthesiologists, that is exactly what happened to them. They wrote a handbook, that made providing anesthesia so easy that monkeys could do it. Then the CRNA's and AA's came into the picture and jumped on board. They started accepting drastically lower salaries, while performing the same exact services as the MD Anesthesiologists. Thus, cheapening the service of the MD's and decreasing their salaries and demand.

The same thing has been happening with the development of the DNP degree. The programs are opening up like rapid fire and they are essentially offering the same exact care as a FM doc. The nursing foundation insists that it will help bridge the gap of access to care. But the problem is that DNP's wont want to work in rural or inner city areas any more than MD's, thus driving down demand and lowering prices and salaries in places that are desirable to live.

I think that for us not to become commoditized, we must stop the advancement of mid levels. We cannot allow our procedures to simply be done by "tooth technicians" or the same thing will happen to us as it has to our MD brothers and sisters.

Sorry for the rant... I am on the speech and debate team and i wrote a speech on this exact issue. I feel pretty strongly about it. Anyway... just my 2 cents.

Ada =//= adha

citylights said:

doesn't dentistry have a midlevel now -- dental therapists? What's interesting about this case is that it was actually the dental profession that created this new group of providers, which contrasts with the medicine/nursing midlevel issue. I don't know much about them and i'm not sure if they are a significant consideration in the future of dentistry... I'm guessing no.

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There's one additional aspect of commoditization and fears of loss of income that I would like to bring to your attention. It may help someone avoid a terrible mistake...

Commoditization means that goods or services are indistinguishable from each other. They are interchangeable for all practical purposes. Note that it is quite possible to take something which is NOT inherently interchangeable and make it so. Like your anesthesiology examples. I have no idea why anyone would want to do this, but perhaps it has to do with larger structures than a dental office, like hospitals and health care corporations, and the herd behavior that exists in these large structures. You'd be surprised how much fear drives corporate behavior. Maintaining the status quo at all costs is the name of the game.

Bertrand Competition or a 'race to the bottom' goes rather like this: if a company, any company, starts lowering its price to gain market share, their competitors tend to start doing the same thing. Each tries to undercut all the others until the price of the product or service in question is just above the cost of production. They've all raced to the bottom.

Example. Walmart comes into town. All the local hardware stores and many other stores close forever because people shop where the cost is lowest and no one can compete with Walmart on cost. Everyone has bottom-raced. OR- a corporate dental office comes into town and the local dentists feel terribly threatened by the same thing.

Game over, right? Wrong.

Many view the results of a race to the bottom as an ending of sorts, of an era that is over. I view it as an astonishing opportunity. Because the era of companies producing more and more average goods and services for average people to have average experiences with is coming to a close. People want more. In the Walmart example, there is now a HUGE vacuum in town and a local hardware store can compete with Walmart on its own terms because Al, the owner, actually talks to people, actually knows them by name, and solves their problems for them. If you don't know how to solder pipe as you remodel your bathroom, Al is going to teach you. Carefully, taking his time, and with a smile.

People want to be delighted, and they want their (interesting) problems solved for them. No company that has raced to the bottom can do that. It's impossible. It violates laws of economics and, indeed, of physics! A company that has made their goods and services as cheap as they can go has no options, no room to maneuver, no resources with which to train staff and do amazing, human things that make themselves indispensible to those who they serve. Nope- all they can do is ring up transactions, and as fast as possible please.

When consumers tire of being taken advantage of in that way, they seek out experiences that make them feel good. They will pay for a feeling of Certainty, they will pay for simple human Connection, and they will pay someone to solve their problems for them.

There will always be entities that sell commodities, and all of us will be driven at times by price alone and will seek them out. But dentistry is not paper towels, laundry soap or gasoline. Increasingly, consumers want to be treated as special when they are making a significant investment in time, effort, and money for a complex good or service, one that makes a diference in their life.

I cannot even count the number of times that someone has come to us after experiencing being treated as a commodity. This occurs with private practitioners as well as corporate dentistry, and some corporate dentistry avoids it, so it's related more to the mindset of the practice owner than it is to the type of practice.

I will limit myself to one example but it's a heartbreaking one- we often see patients who have an asymptomatic molar carious lesion of moderate depth. A composite resin restoration properly bonded with Self-Etch Primers (specifically, the best one, Prelude SE) would treat them beautifully. At the commoditized ofice, they were point blank told they need endo P&C and crown, just off the X-ray, no questions asked about symptoms and no detailed examination of the tooth.

Once we treat them successfully for a fraction of the cost, saving our advanced procedures for those who truly need them, these people are never going to go anyhwere else unless they move too far away.

So, to reiterate my refrain:
Delight your patients.
Solve their (interesting) problems for them.
Provide Certainty and a true human Connection.
Never commoditize anything.

Don't fear those who commoditize dentistry; use it as an opportunity! If they hadn't commoditized, you wouldn't have as much leverage as you do now. You wouldn't have the chance to be so different. We should thank the stupid buggers.

If you do all this, you will never experience a pay cut unless the world has really imploded, in which case we will all have bigger problems than monthly production anyway. But let's not go there. Let's focus on our practices and kick some commoditized ass!

wired202808 said:

Again I was referring to regular general specialties and a few others like pediatrics, etc. Also if you want to talk about garbage then you should probably mention that only a small % of all MD students make it into the Anesthesiology program and they still spend 4 years in a residency while a PA makes real money. I'm not arguing whos going to make the most amount of money, but a PA has a much better end of the stick: they're not on call, they spend less time in school, they earn money faster and they have a lot less stress than an MD.

Oh and unlike Anesthesiologist a PA doesn't have to stress about a patient dying.

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Actually anesthesiologists can moonlight and still outearn a PA during training.

worthy bump, silent cool. as a former pre-dent/dentist/whatever, you are a welcome addition to this forum.

Ferneezy said:

worthy bump, silent cool. as a former pre-dent/dentist/whatever, you are a welcome addition to this forum.

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Not sure if srs?

http://vision.dentistry.vcu.edu/files/2012/09/ISDS-Leadership-Conference-April-2012-041112-1.pptx

.

UCSF you are truly amazing!

periopocket said:

UCSF you are truly amazing!

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No, I just have no better use of my time...

No worries my friend in 2 months time will once again be precious!