$420k for 3-yr orthodontic residency, coming from $380k GP associate job?

[EnhancedIrrigation]

2019 dental grad, 2020 GPR grad that has been working as an associate for the last five years. During this time I have expanded and refined my scope of practice to include molar endo, extractions/implants, clear aligners, etc. I have grown during this time to severely dislike all things restorative (composites, crowns, bridges, veneers, overlays, etc) and just really hate hygiene exams with a passion. I enjoy solving problems, I wish all I did every moment of every day was just solve problems. Too much of my time I feel goes towards periodic exams on healthy patients, diagnosing interproximal decay on patients who are asymptomatic and could not care less, constantly finding PARLs on asymptomatic teeth that patients want no part in fixing despite my efforts to share my concerns with them. I have also grown tired, so quickly of how most people who see me do so with disdain, wishing they never had to be in my chair. I get it - but I hate feeling like the bad guy always.

The lifestyle and efficiency of running an orthodontic practice appeals to me for many reasons. Less variety means fewer insurance codes for admin to work with, fewer procedures for assistants to train on, fewer tools and materials and delivery units needed to provide care. More delegation so that I can spend more time helping patients solve their (malocclusions) problems. Less patient anxiety for obvious reasons. Rare true emergencies, ability to reverse most things you do if you desire.

However, I understand the financial implications of foregoing a reasonable salary to go back to school, paying a steep tuition to get an orthodontic certificate, to potentially land a job that pays less for the first few years out of school, until I could start and grow my own practice. Any advice or strong feelings anyone with career experience may have on my situation? I love orthodontics, but am not sure if the cost of tuition can easily be justified here.

---

Members don't see this ad.

 

[Blueshirts]

Your concerns are valid. You make a healthy enough salary to invest and ease your way entirely out of dentistry - unless you live in a HCOL area. I ask myself similar questions almost daily lol. What it boils down to is how long do you want to work, whether you have a family or are starting one, what do you want your personal life to look like and will the career get in the way of that. I think a lot of us dreamed of a good life, 3 days, make money and relax, but its much different.

 

[D1Bound]

given your income it is a very big step backwards to go pay tuition and not work. I’d consider staying put and making plans for retirement.

 

[juniordentist]

how much are you saving at the moment? what are your living expenses like?

 

[Pablo Sanchez]

So you’re saying it would cost you $420k to pursue orthodontic residency.

And you’d be giving up 3 years of a $380k income.

So it would really cost you over $1.56 million up front to go pursue orthodontic residency.

Let’s just say that you’re 32 years old. If you took that $1.56 million and invested it in the S&P500 and got the historical average return of 10% and then never invested another penny that money would grow to $50 mil by the age of 67.

It would be idiotic. Cut back your days, pursue ownership, limit the procedures you do. Start to plan to retire from dentistry and do something else in a few years. Something! Anything! Anything other than set yourself $1.56 million behind where you are at right now.

 

[OncePreDent]

Realistically, will your income change that much as an orthodontist if you are already making $380k a year? Most likely not. I know many orthodontists who are working 4 days a week and are making $250k-$325k a year. I think from an income standpoint, it doesn't make any sense for you to pursue this orthodontic residency. If you enjoy general dentistry and can see yourself doing it until you retire, I would stick with that. However, if you are miserable and really feel a calling for ortho, then it might be worth the financial loss that @Pablo Sanchez calculated.

Either way, I wouldn't plan on making more income as an orthodontist than as a GD, especially with your current income.

I also agree with @Pablo Sanchez that you should be pursuing ownership.

 

[lylethecrockadile]

I am in a similar situation and I went back to residency. I hate it every day and it was the worst decision of my life, financially, time, everything. Don't do it! Many people warned me about the financial impact but what can I say, I was stubborn and didn't listen. Seeing that you have the math figure out, just don't do it. its not worth it.

 

[toothnumber32]

Everyone who did residency gave up 3 or more years with loss of opportunity cost.

If we were to apply the logic here of losing x years of gp income, then no one would specialize.

Most people against specializing are general dentists on this thread… they are not practice orthodontists.

What if they they are making 800 k or more doing practically nothing all day making their assistants do the work ?

Your done at age 35 but can work (God I hope not) to age 75.

 

[JacquesVallee]

If we were to apply the logic here of losing x years of gp income, then no one would specialize.

But I think the logic is people attending residency are entering a specialty that yields a higher income. Factor in OP is making amazing money already and will have to spend close to half a million dollars on residency, very few would specialize in those circumstances. Rarely is the opportunity cost in the actual millions like OP's is. I'm starting residency soon but would not be heading back if it cost me 420k.

 

[Anondds87]

Everyone who did residency gave up 3 or more years with loss of opportunity cost.

If we were to apply the logic here of losing x years of gp income, then no one would specialize.

Most people against specializing are general dentists on this thread… they are not practice orthodontists.

What if they they are making 800 k or more doing practically nothing all day making their assistants do the work ?

Your done at age 35 but can work (God I hope not) to age 75.

If you have the ability to make 800k as an orthodontist it is not because you got an ortho degree, it is because you are a machine at marketing and referrals and an amazing business owner, in which case if you had those skills you could probably make similar amounts as a GP and skip the 3 years residency.

Most people don't look at the financial side when specialising because it is a bitter pill to swallow. lost income for 3 years and high tuition is hard to recover from.

Instead, I would spend 3 years living like a resident as a general dentist and investing heavily and plan to cut down to 4 days a week in 3 years

 

[Saddleshoes]

2019 dental grad, 2020 GPR grad that has been working as an associate for the last five years. During this time I have expanded and refined my scope of practice to include molar endo, extractions/implants, clear aligners, etc. I have grown during this time to severely dislike all things restorative (composites, crowns, bridges, veneers, overlays, etc) and just really hate hygiene exams with a passion. I enjoy solving problems, I wish all I did every moment of every day was just solve problems. Too much of my time I feel goes towards periodic exams on healthy patients, diagnosing interproximal decay on patients who are asymptomatic and could not care less, constantly finding PARLs on asymptomatic teeth that patients want no part in fixing despite my efforts to share my concerns with them. I have also grown tired, so quickly of how most people who see me do so with disdain, wishing they never had to be in my chair. I get it - but I hate feeling like the bad guy always.

The lifestyle and efficiency of running an orthodontic practice appeals to me for many reasons. Less variety means fewer insurance codes for admin to work with, fewer procedures for assistants to train on, fewer tools and materials and delivery units needed to provide care. More delegation so that I can spend more time helping patients solve their (malocclusions) problems. Less patient anxiety for obvious reasons. Rare true emergencies, ability to reverse most things you do if you desire.

However, I understand the financial implications of foregoing a reasonable salary to go back to school, paying a steep tuition to get an orthodontic certificate, to potentially land a job that pays less for the first few years out of school, until I could start and grow my own practice. Any advice or strong feelings anyone with career experience may have on my situation? I love orthodontics, but am not sure if the cost of tuition can easily be justified here.

I suspect your dissatisfaction comes more from the fact that you are stuck doing most of the "scut work" as an associate.
If one were to invest the same time and money in developing one's own practice as an owner operator that could all change.
Private practice owner operators spend all day solving problems. (Not just dental problems!)

 

[EnhancedIrrigation]

how much are you saving at the moment? what are your living expenses like?

I have $320k in savings and COL is $30k annually (living, food, misc). I have $100k left in loans. I'm 31yrs old.

Realistically, will your income change that much as an orthodontist if you are already making $380k a year? Most likely not. I know many orthodontists who are working 4 days a week and are making $250k-$325k a year. I think from an income standpoint, it doesn't make any sense for you to pursue this orthodontic residency. If you enjoy general dentistry and can see yourself doing it until you retire, I would stick with that. However, if you are miserable and really feel a calling for ortho, then it might be worth the financial loss that @Pablo Sanchez calculated.

Either way, I wouldn't plan on making more income as an orthodontist than as a GD, especially with your current income.

I do acknowledge that orthodontic *associates* may only have an income of $250k-350k, but that's also because a majority of their jobs are for OSOs that IMO underpay them a good bit. Where I see value is in practice ownership as an orthodontist - the most recent CWA practice comparison report puts 1 doc GP practices at $500k net income annually, and 1 doc Ortho practices at $900k net income annually, which is a substantial difference - especially when considering the work they're doing is much more hands-off given the nature of their profession.

If I had an orthodontic practice I knew I could buy into day one out of residency, I wouldn't feel as worried about earning back my lost income. But I do notice a growing trend of fewer private practice opportunities and more OSO/DSO opportunities that inherently don't pay as well as they really should (per diems usually).

 

[OncePreDent]

If you have the ability to make 800k as an orthodontist it is not because you got an ortho degree, it is because you are a machine at marketing and referrals and an amazing business owner, in which case if you had those skills you could probably make similar amounts as a GP and skip the 3 years residency.

Completely agree. Some orthodontists make millions a year. There are also GD's that make millions a year. You'll never get there working as an associate. Additionally, you will likely need to own multiple practices and hire associates.

One ortho I know worked as a GD for 10 years and then went to ortho residency (2-year program no tuition). He has told me many times that he made significantly more every year working as a GD than he ever has as an orthodontist.

 

[veryhappylabrador]

I am in a similar situation and I went back to residency. I hate it every day and it was the worst decision of my life, financially, time, everything. Don't do it! Many people warned me about the financial impact but what can I say, I was stubborn and didn't listen. Seeing that you have the math figure out, just don't do it. its not worth it.

What specialty?

 

[Pablo Sanchez]

If we were to apply the logic here of losing x years of gp income, then no one would specialize.

That’s been my argument in support of general dentistry for years. The reality of the situation is that opportunity cost is a real thing and IS something that should be considered, not simply ignored because everyone else ignores it. Not only does residency take time. You miss out on the most important and powerful investment years of your life.

 

[bahter]

The luxury of speciality practice is that you dont have to run around like a chicken with it's head cut off to make a comparable or higher wage. The opportunity does cost but there are ways to mitigate it, such a moonlighting. Sounds like you have a decent amount saved up to help ease things along the way. If you are really passionate about it, then go for it.

 

[Big Time Hoosier]

If you are really passionate about it, then go for it.

To me it doesn’t seem the OP is passionate about ortho. It seems they are just hoping the grass is greener…

Big Hoss

 

[charlestweed]

I have $320k in savings and COL is $30k annually (living, food, misc). I have $100k left in loans. I'm 31yrs old.


I do acknowledge that orthodontic *associates* may only have an income of $250k-350k, but that's also because a majority of their jobs are for OSOs that IMO underpay them a good bit. Where I see value is in practice ownership as an orthodontist - the most recent CWA practice comparison report puts 1 doc GP practices at $500k net income annually, and 1 doc Ortho practices at $900k net income annually, which is a substantial difference - especially when considering the work they're doing is much more hands-off given the nature of their profession.

If I had an orthodontic practice I knew I could buy into day one out of residency, I wouldn't feel as worried about earning back my lost income. But I do notice a growing trend of fewer private practice opportunities and more OSO/DSO opportunities that inherently don't pay as well as they really should (per diems usually).

It's good that you've saved $320k. It's not easy to have the discipline to live on a $30k/yr budget, which is essentially the same as "living like a student" lifestyle, when you have a very good income. If you're single and don't have anyone to support, I think you should go for it. With the saving amount that you already have, you will graduate with very low debt amount. And if you continue to maintain this modest lifestyle for a few more years after graduation, you will be fine.

DSO offices actually pay their associate orthodontists more. They can afford to do so because they have much lower overhead. They get good discounts on the supplies by buying them in bulk. They make their ortho staff travel to multiple offices so they don’t have to hire a lot of them. Rents and utilities are already paid for by the production from the GP department. Some DSO even offer benefits like health insurance, malpractice insurance and 401k. Another benefit of working for DSO is you have full autonomy in making tx decisions. In private practice, you have to work with a boss, who may not have the same tx philosophy as yours. DSO offices usually have more patients and are able to give you more work days to keep you busy. These are the reasons why I’ve stayed at this same DSO for more than 20 years. Ortho is a wonderful profession. Once you gain enough experience (from treating high patient volume) and deal with all kinds of complications, the job will become very easy and enjoyable. And you don’t want to retire.

Keep in mind that your success as an orthodontist owner depends on the relationship that you have with your referring GPs. Buying an existing ortho practice that already has a good positive cash flow doesn’t guarantee that you will continue to enjoy this same benefit when you take over. You have to continue to go door to door to meet the existing and new referring GPs introduce yourself to them.....to strengthen the trust that the GPs have in you. You have to continue to work hard to keep the existing patients happy so they’ll refer their friends and relative to your office. As I get older, I lose the energy/motivation to do these marketing things. That’s why the production is declining. I had to close one of my 4 offices a few years ago. It’s ok because I already paid off all my debt. It’s time for the younger generation to take over this wonderful profession.

 

[toothnumber32]

That’s been my argument in support of general dentistry for years. The reality of the situation is that opportunity cost is a real thing and IS something that should be considered, not simply ignored because everyone else ignores it. Not only does residency take time. You miss out on the most important and powerful investment years of your life.

yes that is very true. I was in residency for four years. In that time housing prices gone way up in appreciation.
Obviously I caught up to my dental school classmates and surpassed them quickly.

But it is very true you are trading your best years.

My attendings did omfs in 3 years. Thats what it was like back in the 80s. And here they are teaching us. I wish my residency was 3 years long.
At least for omfs they pay us for our entire 4 years.

 

[Anondds87]

I have $320k in savings and COL is $30k annually (living, food, misc). I have $100k left in loans. I'm 31yrs old.


I do acknowledge that orthodontic *associates* may only have an income of $250k-350k, but that's also because a majority of their jobs are for OSOs that IMO underpay them a good bit. Where I see value is in practice ownership as an orthodontist - the most recent CWA practice comparison report puts 1 doc GP practices at $500k net income annually, and 1 doc Ortho practices at $900k net income annually, which is a substantial difference - especially when considering the work they're doing is much more hands-off given the nature of their profession.

If I had an orthodontic practice I knew I could buy into day one out of residency, I wouldn't feel as worried about earning back my lost income. But I do notice a growing trend of fewer private practice opportunities and more OSO/DSO opportunities that inherently don't pay as well as they really should (per diems usually).

so you have 320k in savings. At 7% thats earning you 21k a year. your current salary as an associate is 380k a year. So essentially you're earning 400k a year as is. If your living expenses are 30k a year, you should be able to save 200k after tax a year. If you do that for 3 more years, you'll have a million dollars invested. Which will earn you 70k a year, plus working as a GP which will likely be above 400k a year. So you could easily find yourself earning 500k a year on the path you're currently on in 3 years.
Or, if you do ortho, you will be probably negative 200k with no savings at all, and absolutely earning less than 500k a year

 

[toothnumber32]

so you have 320k in savings. At 7% thats earning you 21k a year. your current salary as an associate is 380k a year. So essentially you're earning 400k a year as is. If your living expenses are 30k a year, you should be able to save 200k after tax a year. If you do that for 3 more years, you'll have a million dollars invested. Which will earn you 70k a year, plus working as a GP which will likely be above 400k a year. So you could easily find yourself earning 500k a year on the path you're currently on in 3 years.
Or, if you do ortho, you will be probably negative 200k with no savings at all, and absolutely earning less than 500k a year

I don’t know anyone who can live off of 30 k a year. Who does this ?

Malpractice insurance, disability insurance. Car insurance home insurance.
Mortgage payments on ones house.

You’re essentially saying he lives with his parents or lives in a studio, never eating out etc. driving a used Camry etc. don’t even talk about having a family kids etc.

 

[juniordentist]

Well if he studies ortho he will be living off 30k a year as a resident. Hence the term "living like a resident". So the next 3 years he will be living off 30k a year with either option...

 

[lylethecrockadile]

What specialty?

PEDO

 

[EnhancedIrrigation]

I don’t know anyone who can live off of 30 k a year. Who does this ?

Malpractice insurance, disability insurance. Car insurance home insurance.
Mortgage payments on ones house.

You’re essentially saying he lives with his parents or lives in a studio, never eating out etc. driving a used Camry etc. don’t even talk about having a family kids etc.

Malpractice is 4k a year paid by work, I don't have disability insurance cause that's a waste of money lol, jk (but actually). Car insurance is 2k annually on a paid off 2019 Japanese generic hybrid sedan. 2k a year for gas and maybe 500 for routine maintenance. My rent+utilities is 1,650 a month because I have a roommate (significant other), no kids. Maybe 750 for food a month (Costco baby!) - mostly just eat at home. And maybe 5k a year for travel. So in total I'm doing 39k, not 30k!

 

[OncePreDent]

I don’t know anyone who can live off of 30 k a year. Who does this ?

Malpractice insurance, disability insurance. Car insurance home insurance.
Mortgage payments on ones house.

You’re essentially saying he lives with his parents or lives in a studio, never eating out etc. driving a used Camry etc. don’t even talk about having a family kids etc.

All dental students, lol. I live off around $20k a year. pay around $1k per month for housing (w/roommates)

 

[toothnumber32]

Malpractice is 4k a year paid by work, I don't have disability insurance cause that's a waste of money lol, jk (but actually). Car insurance is 2k annually on a paid off 2019 Japanese generic hybrid sedan. 2k a year for gas and maybe 500 for routine maintenance. My rent+utilities is 1,650 a month because I have a roommate (significant other), no kids. Maybe 750 for food a month (Costco baby!) - mostly just eat at home. And maybe 5k a year for travel. So in total I'm doing 39k, not 30k!

Thats incredibly impressive


But one day you will be spending more. A lot more.
You will own a home in an expensive area. Have kids. Send them to private schools. They will play competitive sports. Be part of AAU teams. Private coaching. Those days will be long gone my friend. Just wait.

 

[EnhancedIrrigation]

Thats incredibly impressive


But one day you will be spending more. A lot more.
You will own a home in an expensive area. Have kids. Send them to private schools. They will play competitive sports. Be part of AAU teams. Private coaching. Those days will be long gone my friend. Just wait.

One day!! Hopefully soon haha!

 

[Big Time Hoosier]

I don't have disability insurance cause that's a waste of money lol

Big Hoss

 

[Thehighwind87]

Orthodontics is NOT the same what it used to be. When I grew up and got braces in 2000s- the best job was orthopedic. Porsche 911 4 days a week country club.

Todays it’s a bunch of debt and gps who are doing Invisalign taking your turf. Also you have much more competition from dsos and those graduates who grew up with the 2000 dream lifestyle so they went into ortho. Plus older orthos just don’t retire cuz they don’t really have to work- their assistants do it. So good luck trying to break into an area with an existing ortho.

You also have to market well. Go advertise. To sponser a team. Go to fairs and handout toothbrushes, be active in the community. Go suck up to gps. Maybe twirl a toothbrush sign on a busy corner. That to me sounds terrible.

You also have to have a decent large office- 5-10 chairs with big staff. I can barely handle 4 staff members. If I had to manage 10-15 staff with their drama and their raises and hiring and firing - I would honestly quit dentistry all together.

Ortho used to be the job. Now it’s not. It’s just a job with lot of debt and a lot of extra work managing staff and marketing. On the contrary if you have an excellent ortho office- you are basically rolling in dough. But if you making near 400k as a GP that’s good enough already.

 

[juniordentist]

The things that make ortho great also make it terrible. Great things are: you can practice til you are really old because it's so easy on your body (orthodontists don't retire - they die), you can hire assistants to do all your work for you, if you get busier you just hire more assistants rather than associates. Orthodontists can see 100 patients a day.

But these are all negatives if you are a young orthodontist. It means all the established guys are getting all the patients, they're not retiring, they have a capacity to see a huge volume of patients - so it's not like someone can come and see you because the older established guy has a waitlist.

It's tough out there as a young ortho. And the DSOs know this. So they pay a daily rate which isn't great once you factor in how many patients you see.

 

[JacquesVallee]

The things that make ortho great also make it terrible. Great things are: you can practice til you are really old because it's so easy on your body (orthodontists don't retire - they die), you can hire assistants to do all your work for you, if you get busier you just hire more assistants rather than associates. Orthodontists can see 100 patients a day.

But these are all negatives if you are a young orthodontist. It means all the established guys are getting all the patients, they're not retiring, they have a capacity to see a huge volume of patients - so it's not like someone can come and see you because the older established guy has a waitlist.

It's tough out there as a young ortho. And the DSOs know this. So they pay a daily rate which isn't great once you factor in how many patients you see.

Add to this that Ortho has been proliferating so many programs churning out way too many residents. Georgia School of Orthodontics takes 45 residents per class now. Their tuition and fees come out to greater than 130k per year for 3 years. When you factor in cost of living and interest, you can expect to pay 500k+ for this program.

I was browsing the programs on the AAO website and I was shocked to see almost every one has such hefty tuition with a very small stipend- if one at all. The barrier for entry for getting into an ortho program now is so much lower than it was. It's sad to me nobody is doing anything to stop this. Ortho is such a cool field. Shout out to OMFS for being a dental specialty that has consistently maintained a very high barrier of entry.

 

[charlestweed]

You also have to market well. Go advertise. To sponser a team. Go to fairs and handout toothbrushes, be active in the community. Go suck up to gps. Maybe twirl a toothbrush sign on a busy corner. That to me sounds terrible.

True, especially if you are a new unknown guy in town. I hated doing marketing but I had to do it because this was the only way for me to get the patients to walk into my office so I could pay bills and staff salaries. I’ve never been good at doing marketing. That’s why I have to charge low fees to attract more patients and see high patient volume to make up for this. Until now (after more than 20 years of practicing), I still have to work for the DSO to supplement my income. There’s a saying “work smarter and not harder.” Since I wasn’t smart at running my business, working harder was the only way for me to get ahead. At least practicing ortho is not as hard on the hands and body as practicing general dentistry.

 

[Thehighwind87]

Malpractice is 4k a year paid by work, I don't have disability insurance cause that's a waste of money lol, jk (but actually). Car insurance is 2k annually on a paid off 2019 Japanese generic hybrid sedan. 2k a year for gas and maybe 500 for routine maintenance. My rent+utilities is 1,650 a month because I have a roommate (significant other), no kids. Maybe 750 for food a month (Costco baby!) - mostly just eat at home. And maybe 5k a year for travel. So in total I'm doing 39k, not 30k!

I remember those days before kids.

Now my monthly is:

Now it’s 4k fixed mortgage cost, 2-3k credit card monthly, 2k health insurance.

My fixed costs alone is 8-9k for a family of 4 in a month. Couple in a few vacations and you are spending lots in a years time and you can see how you are literally “broke” as a dentist making 6 figures with a large debt load.

Everyone think that they can live like a student forever until you have kids and a wife and a mortgage.

By the way my mortgage right now if you bought my house at today’s rates and inflated levels would be 8-9k a month. My house price doubled since Covid.

Then the real costs come.

 

[toothnumber32]

My house price doubled since Covid.

Exactly
While those are in residency they come out with more debt, lost income and on top of that houses the at have doubled in price.

You better be certain it’s financially worth it.

Honestly I would hesitate to recommend anything other than omfs. I’m obviously biased.

 

[OncePreDent]

Exactly
While those are in residency they come out with more debt, lost income and on top of that houses the at have doubled in price.

You better be certain it’s financially worth it.

Honestly I would hesitate to recommend anything other than omfs. I’m obviously biased.

I agree, OMFS is for the the most lucrative specialty out of any. I think Dental anesthesiologist is another one, but nothing compares to OMFS

 

[JacquesVallee]

I agree, OMFS is for the the most lucrative specialty out of any. I think Dental anesthesiologist is another one, but nothing compares to OMFS

Endo, OMFS, and DA are the most profitable dental specialties for sure. Ortho was king a decade or two ago. The main draw to Ortho now is that it is by far the best lifestyle.

 

[Faefly]

Orthodontics is amazing. Don't listen to doubters and Nay sayers! Make the leap!

It is not about the money..it is about how you wanna spend the rest of your life!

 

[OncePreDent]

It is not about the money..it is about how you wanna spend the rest of your life!

It feels like something someone would say who would happily pay $600k for dental school and another $500k for an orthodontic residency...

Money isn’t everything in life, but it is a powerful tool that gives you options and freedom. By choosing the orthodontic path, you’re investing in the hope that the professional fulfillment and long-term financial returns are worth the upfront costs.

To @EnhancedIrrigation - Absolutely pursue your passions, but go in with both eyes open regarding the financial side. Right now, you’re making a great income as a general dentist - $380,000 per year. If you enter an orthodontic residency, not only will you be spending $420k on tuition and related costs, but you’ll also be giving up your current income for three years. That’s more than a million dollars in lost earnings on top of the direct tuition expenses. The total opportunity cost can easily cross $1.5 million when you factor in both out-of-pocket costs and foregone salary.

Let's play with math: You make $380k - after tax in MN (very unfriendly tax state) you would be left with: $229,300 minus expenses of $39k = $190k Savings per year (Total $570k!). Say you invest this in the S&P 500 for the next 40 years with an annual return of 10% and never invest a single penny again:

$25,797,775.67!!!
This is an absurd amount of money, and I don't think it would be possible for you to make this as an orthodontist or remotely close to this figure if you choose to go to the ortho route. For the next three years, if you continue to work and live the way you are, you can set enough money aside to never have to put a single cent towards retirement again.

@EnhancedIrrigation What are your thoughts on all this?

Edit: This doesn't even including adding $420k debt after the 3 year lose income. The next 3 years could set yourself up for life.

 

[toothnumber32]

One more thing I want to add -

Going back to school as a resident… yes your learning but your generally treated like garbage.

I had the best attendings in the country - they let me cut all the cases I want and I had a great volume of cases to operate. Really couldn’t ask for more.

But that doesn’t change the fact that I was yelled at and verbally abused for year lol. Hahaha I look back and I’m like. No way in hell I’d do that ever again.

I’m sure the volume control is turned down a little bit in ortho residency but it still has got to be frustrating like dental school. I wouldn’t go back after being out for a good number of years making decent cash.

 

[Thehighwind87]

Orthodontics is amazing. Don't listen to doubters and Nay sayers! Make the leap!

Orthodontics is amazing. Don't listen to doubters and Nay sayers! Make the leap!

It is not about the money..it is about how you wanna spend the rest of your life!

Lol spoken like someone without responsibilities in life. You know kids mortgage loan payments. You will understand one day.

 

[charlestweed]

I don't think we need to give the OP advice about finance. I think he should be the one who should give some of us advice about how to save and how to live within our means. I remember the very first thing i did right after graduation was getting myself a BMW....that was so stupid. The OP has accomplished so much for having been just 5 yrs out of school.....$320k saved, making almost $400k a yr, and only has $100k studentloan debt, which he can easily pay off right now if he wants to. I know plenty of young 30+ yo dentists who are drowning in debt because they can't control their spending habits. I am sure he will be fine if he chooses to go back to school for ortho.

 

[Anondds87]

It feels like something someone would say who would happily pay $600k for dental school and another $500k for an orthodontic residency...

Money isn’t everything in life, but it is a powerful tool that gives you options and freedom. By choosing the orthodontic path, you’re investing in the hope that the professional fulfillment and long-term financial returns are worth the upfront costs.

To @EnhancedIrrigation - Absolutely pursue your passions, but go in with both eyes open regarding the financial side. Right now, you’re making a great income as a general dentist - $380,000 per year. If you enter an orthodontic residency, not only will you be spending $420k on tuition and related costs, but you’ll also be giving up your current income for three years. That’s more than a million dollars in lost earnings on top of the direct tuition expenses. The total opportunity cost can easily cross $1.5 million when you factor in both out-of-pocket costs and foregone salary.

Let's play with math: You make $380k - after tax in MN (very unfriendly tax state) you would be left with: $229,300 minus expenses of $39k = $190k Savings per year (Total $570k!). Say you invest this in the S&P 500 for the next 40 years with an annual return of 10% and never invest a single penny again:
View attachment 400114

$25,797,775.67!!!
This is an absurd amount of money, and I don't think it would be possible for you to make this as an orthodontist or remotely close to this figure if you choose to go to the ortho route. For the next three years, if you continue to work and live the way you are, you can set enough money aside to never have to put a single cent towards retirement again.
View attachment 400117
@EnhancedIrrigation What are your thoughts on all this?

Edit: This doesn't even including adding $420k debt after the 3 year lose income. The next 3 years could set yourself up for life.

The math checks out. The thing I don't understand, is why aren't there more associates out there who are insanely financially well off? It seems the owners are the ones who are most successful, but the math clearly shows that if you are diligent with investing you could be set for life if you do 5-10 years as an associate at this level of income. Is it because people are starting with too much debt? Or is it because people aren't diligent with their spending once they start earning money? If I could start my career over, I would say go straight into that associate job, put in 10 years and at that point you would be set for the rest of your life. But I've never met an associate who has done this...

 

[Thehighwind87]

The math checks out. The thing I don't understand, is why aren't there more associates out there who are insanely financially well off? It seems the owners are the ones who are most successful, but the math clearly shows that if you are diligent with investing you could be set for life if you do 5-10 years as an associate at this level of income. Is it because people are starting with too much debt? Or is it because people aren't diligent with their spending once they start earning money? If I could start my career over, I would say go straight into that associate job, put in 10 years and at that point you would be set for the rest of your life. But I've never met an associate who has done this...

Life isn’t straightforward.

1) the market doesn’t guarantee future returns. 2001-2008 the market really moved nowhere. If you bought at the top you were underwater.

2) life isn’t that straightforward. You could get fired from your associate job. You could get married have kids. I used to pay 500$ in 2010 sharing a room with my roommates making 50$ a hour paying like 300$ for health insurance.

Today I pay 2k in health insurance, 4000$ for my mortgage and so on.

 

[veryhappylabrador]

2019 dental grad, 2020 GPR grad that has been working as an associate for the last five years. During this time I have expanded and refined my scope of practice to include molar endo, extractions/implants, clear aligners, etc. I have grown during this time to severely dislike all things restorative (composites, crowns, bridges, veneers, overlays, etc) and just really hate hygiene exams with a passion. I enjoy solving problems, I wish all I did every moment of every day was just solve problems. Too much of my time I feel goes towards periodic exams on healthy patients, diagnosing interproximal decay on patients who are asymptomatic and could not care less, constantly finding PARLs on asymptomatic teeth that patients want no part in fixing despite my efforts to share my concerns with them. I have also grown tired, so quickly of how most people who see me do so with disdain, wishing they never had to be in my chair. I get it - but I hate feeling like the bad guy always.

The lifestyle and efficiency of running an orthodontic practice appeals to me for many reasons. Less variety means fewer insurance codes for admin to work with, fewer procedures for assistants to train on, fewer tools and materials and delivery units needed to provide care. More delegation so that I can spend more time helping patients solve their (malocclusions) problems. Less patient anxiety for obvious reasons. Rare true emergencies, ability to reverse most things you do if you desire.

However, I understand the financial implications of foregoing a reasonable salary to go back to school, paying a steep tuition to get an orthodontic certificate, to potentially land a job that pays less for the first few years out of school, until I could start and grow my own practice. Any advice or strong feelings anyone with career experience may have on my situation? I love orthodontics, but am not sure if the cost of tuition can easily be justified here.

Did you get in to a 3-year, $420k program or is this a hypothetical question?

 

[EnhancedIrrigation]

Did you get in to a 3-year, $420k program or is this a hypothetical question?

I’ve been accepted, and am deliberating on whether to pursue it or not. Financially, it seems like not a great idea. Emotionally, I’d go if I knew I wasn’t shooting myself in the foot financially….

 

[Big Time Hoosier]

I’ve been accepted, and am deliberating on whether to pursue it or not. Financially, it seems like not a great idea. Emotionally, I’d go if I knew I wasn’t shooting myself in the foot financially….

Is it the Georgia School of Orthodontics?

Big Hoss

 

[toothnumber32]

Is it the Georgia School of Orthodontics?

Big Hoss

Dude you can’t ask that lol

 

[yappy]

The math checks out. The thing I don't understand, is why aren't there more associates out there who are insanely financially well off? It seems the owners are the ones who are most successful, but the math clearly shows that if you are diligent with investing you could be set for life if you do 5-10 years as an associate at this level of income. Is it because people are starting with too much debt? Or is it because people aren't diligent with their spending once they start earning money? If I could start my career over, I would say go straight into that associate job, put in 10 years and at that point you would be set for the rest of your life. But I've never met an associate who has done this...

In my experience most associates that are capable of earning a high income as an associate quickly become owners.

 

[Pablo Sanchez]

Would your guys’ opinions change if this was the same situation but the specialty was endo?

Would it cost $1.56 million to go back to residency?

 

[veryhappylabrador]

Lets say a million (200k tuition, 800k lost opportunity cost)

In my opinion, endo starting salaries are higher (for an associate endo vs. ortho) and endo jobs are more readily available (only have the see a patient once vs. ortho seeing a patient monthly for 2-3 years). Plus people price shop orthodontists, they don't usually price shop endodontists.

So I would say that even at $1 million cost (including opportunity cost), endo is worth it.