ADA 2019 Income Report

[charlestweed]

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Yep. They raised the ortho fees last year. Admittingly .... starts have been down, but they're sticking to their plan. I don't mind. I prefer to see 50-60 patients a day compared to Risas Dental 100 patients per day.

That's the right strategy to raise your fees. Competing in the low fee arena just seems like racing to the bottom of the barrel.

A whole 10 years 😱 . You must be worn out. Shot. Ruined for life. You better pace yourself you ole curmudgeon 😀 . But seriously ....good for you.

When the corp I work for raised the ortho fees about 1-2 years ago, I told the regional manager that this was a mistake. She agreed with me but she couldn't do anything about it either. Starts have gone down. I used to see 80+ patients a day. Now, like you, I only see 50-60 patients a day. I don't mind either....more time for me to listen to the news and to chat on the SDN forum....and still get the same guaranteed daily pay.

I've kept the fees the same at my office and we continue to maintain healthy number of starts every month. There are fixed expenses to pay. It doesn't matter if I have 0 start or 10 starts in a day; the assistants get paid the same. So why let them sit around doing nothing? When I work for myself, I'd rather work non-stop and produce than sitting around doing nothing.

 

[charlestweed]

Yeah. I don't like rich people either. Driving around in their Teslas. Living in their big houses. Luxury everything.
Just kidding. Just giving you a hard time. 🙂

But you are right. Affluent patients are more demanding and I do not miss treating them. Low income patients are very appreciative of the care they receive.

Things have changed and this "entitled" Baby Boomer still cherishes those early years where patients came to you because of your reputation with past patients, quality treatment and validation from referring dentists.

Word-of-mouth is still king for growing your dental/ortho practice. Everybody wants good treatment results at reasonable price. And if you can deliver both, you continue to get new patients. With increase in number of offices (due to increase in number of new grad dentists/orthodontists), patients now have more choices to pick where they want to get dental care at. The offices that offer patients more choices (ie accepting most insurances, affordable payment plans, weekend and late office hours etc) will beat the offices that don't.

Model S and model X are getting a lot cheaper now. We got another one. We are now 100% electric😀.

 

[ToothJockey]

So I've been doing some reading, and it seems like even medicine might see income stagnate in the future. It's been increasing like crazy the past decade or 2, but that was due to supply and demand, and now physician productivity is not keeping up with compensation. Of course, declining insurance reimbursement have a lot to do with it, and increasing overhead costs. Since lots of physicians are employed, they can't really do much about a paycut in the future.

The Physician Compensation Bubble Is Looming

Physician salary has evolved the hands of many market forces, with changes in inflation rates perhaps the most significant threat to compensation rates.

www.physicianleaders.org

Future for both medicine and dentistry aren't the brightest.

This might sound wack, but I hope the costs of schooling skyrocket so that there's lowered supply, and therefore more demand for dentists. It will be worth it for the profession in the long run imo

Are You A Real Millionaire? $3 Million Is The New $1 Million

Although being a millionaire sounds nice, it's not that impressive anymore thanks to inflation. In order to be a real millionaire, you will need to have a net worth of at least $3 million, not $1 million. A $1 million net worth provided a great lifestyle before 1990. Not so much today. If you...

www.financialsamurai.com

This blog post does a good job pointing out the effects of inflation, and possibly also why dentists aren't retiring.

 

[Cold Front]

Model S and model X are getting a lot cheaper now.
View attachment 289493

How much cheaper? Model 3 is the cheapest and it’s close to $40k.



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[2TH MVR]

So I've been doing some reading, and it seems like even medicine might see income stagnate in the future. It's been increasing like crazy the past decade or 2, but that was due to supply and demand, and now physician productivity is not keeping up with compensation. Of course, declining insurance reimbursement have a lot to do with it, and increasing overhead costs. Since lots of physicians are employed, they can't really do much about a paycut in the future.

The Physician Compensation Bubble Is Looming

Physician salary has evolved the hands of many market forces, with changes in inflation rates perhaps the most significant threat to compensation rates.

www.physicianleaders.org

Future for both medicine and dentistry aren't the brightest.

This might sound wack, but I hope the costs of schooling skyrocket so that there's lowered supply, and therefore more demand for dentists. It will be worth it for the profession in the long run imo

Are You A Real Millionaire? $3 Million Is The New $1 Million

Although being a millionaire sounds nice, it's not that impressive anymore thanks to inflation. In order to be a real millionaire, you will need to have a net worth of at least $3 million, not $1 million. A $1 million net worth provided a great lifestyle before 1990. Not so much today. If you...

www.financialsamurai.com

This blog post does a good job pointing out the effects of inflation, and possibly also why dentists aren't retiring.

Sometimes too much analysis leads to paralysis. Don't overthink this. Stick with the profession you're going to be happy with. Whether it's medicine or dentistry. Either option will be fine. There will always be sick people and people with teeth issues. Exceptional people will usually succeed in any endeavour. You'll drive yourself crazy reading forum opinions and other studies.

There are no guarantees in life regardless of the profession you choose. Yes ... dentistry has changed, but the younger dentists are so much more prepared for this new market (if they can keep their debt low).

I chose dentistry (ortho) over medicine mostly because of lifestyle. I owe much of my success (however you define success) to dentistry.

So don't overthink this. No profession is perfect, but let's be real. MDs and Dentists have pretty good lives. JUST KEEP YOUR DEBT REASONABLE.

 

[charlestweed]

How much cheaper? Model 3 is the cheapest and it’s close to $40k.

$30-40k cheaper. The cost of the performance model S (0-60 in 2.4 seconds) was $150-160k before 2018. Now it’s only $110-120k. I bought the long range model S (0-60 in 3.7 seconds) in 2018 for $125k. Now, you can get it for $95k. The newer model X and model S are not only cheaper; they also get newer motors that help increase their ranges to 325 miles and 372 miles, respectively.

Another beauty of owning a Tesla is you don’t have to bring the car in for maintenance services for the first 2-3 years. A Tesla with 100k miles still drives like a brand new car….no engine noise/vibration…. and silky smooth acceleration. Just change the tires and you are good to go. With the saving in gasoline and maintenance cost, a $95k Telsa is cheaper than a $70k German car if you plan to keep the car for 5 years. Once you drive a Tesla, you'll never go back to a gas car....you are spoiled for life.


Edit: $25-35k cheaper because you no longer get the $7500 tax credit from the government.

 

[Cold Front]

Edit: $25-35k cheaper because you no longer get the $7500 tax credit from the government.

Plus they opened up the giga factory couple of years ago - to beef up their production. That significantly reduced the cost to produce a Tesla.

I have a Porsche Macan Turbo and a Mercedes G wagon. I’m not ready to jump to Tesla yet. Waiting for them to produce 400+ miles engines first, which should happen in 18-24 months. My dealership sales group is talking me into the Porsche Taycan - which is all electric like Tesla, but Porsche doesn’t have the electric grid infrastructure like Tesla does, yet.


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[Cold Front]

So I've been doing some reading, and it seems like even medicine might see income stagnate in the future. It's been increasing like crazy the past decade or 2, but that was due to supply and demand, and now physician productivity is not keeping up with compensation. Of course, declining insurance reimbursement have a lot to do with it, and increasing overhead costs. Since lots of physicians are employed, they can't really do much about a paycut in the future.

The Physician Compensation Bubble Is Looming

Physician salary has evolved the hands of many market forces, with changes in inflation rates perhaps the most significant threat to compensation rates.

www.physicianleaders.org

Future for both medicine and dentistry aren't the brightest.

This might sound wack, but I hope the costs of schooling skyrocket so that there's lowered supply, and therefore more demand for dentists. It will be worth it for the profession in the long run imo

Are You A Real Millionaire? $3 Million Is The New $1 Million

Although being a millionaire sounds nice, it's not that impressive anymore thanks to inflation. In order to be a real millionaire, you will need to have a net worth of at least $3 million, not $1 million. A $1 million net worth provided a great lifestyle before 1990. Not so much today. If you...

www.financialsamurai.com

This blog post does a good job pointing out the effects of inflation, and possibly also why dentists aren't retiring.

Bottom line: The path to success for future dentists will be a much steeper gradient every year, but for now - doable. More and more new grads will stall or choose not be able to climb that slope all together due to huge debt. Associate dentists will grow in numbers overtime, and solo private offices will decline - partly due to the additional cost to open a dental office will go up, and females who are not inclined to own a practice will dominate the profession in the future.


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[charlestweed]

Plus they opened up the giga factory couple of years ago - to beef up their production. That significantly reduced the cost to produce a Tesla.

I have a Porsche Macan Turbo and a Mercedes G wagon. I’m not ready to jump to Tesla yet. Waiting for them to produce 400+ miles engines first, which should happen in 18-24 months. My dealership sales group is talking me into the Porsche Taycan - which is all electric like Tesla, but Porsche doesn’t have the electric grid infrastructure like Tesla does, yet.

If Tesla can make a cybertruck, which you can place an order now, with 500-mile range, I am sure the company will be able to make their future model S and X to have such long range as well. Taycan is a beautiful car both inside and outside. But who would want to pay $150-180k for a slower car that has a pathetically low 201-mile range....and no supercharging network? 201 mile range, however, should still be plenty for every day driving.

I wouldn't buy a new car when it was first released, even for a reputable company like Porsche. Tesla's earlier model S's and model X's had a lot of issues and recalls. Now, they are almost perfect.

 

[charlestweed]

Bottom line: The path to success for future dentists will be a much steeper gradient every year, but for now - doable. More and more new grads will stall or choose not be able to climb that slope all together due to huge debt. Associate dentists will grow in numbers overtime, and solo private offices will decline - partly due to the additional cost to open a dental office will go up, and females who are not inclined to own a practice will dominate the profession in the future.

So I guess dentistry will be better for the male dentists. The male dentist owners will have fewer competitors in the future because the female dentists, who will be the majority of the dentists, are not incline to own a practice.

Some dental students on this SDN forum claimed that the majority of their classmates are from wealthy families. If this is true, then I guess the majority of the future dentists should do fine because they have their wealthy parents, who help pay for everything.

 

[Ali527]

Lolll so your a Doctor because to be a Doctor is prestigious for your family...oh my gosh, Hello we are in XXI century, wake up!!

Lol you forgot about pharmacy, Dr. Charlestweed. Somehow that is still seen as a prestigious thing in the Asian community. Most Asian parents have no clue about the pharmacy job crisis or how desperately pharmacy schools need to fill their seats to the point that they will take anybody. Asian people are just proud that their son or daughter will graduate pharm school and become a “doctor.”
Someone mentioned engineering. I think that depends on the specific culture. My Asian family does not see engineering as prestigious, most of my relatives look down on engineering because it is just a 4-year degree and thus “a dime a dozen” (their words, not mine).



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[ToothJockey]

My parents aren't "rich", but they will help me pay for school, so I'm looking to go into ownership right away. I feel like dentistry will definitely be divided in the future, either you are struggling with debt and too scared to buy a practice, so you associate. Or you are a practice owner who is succeeding and can hire those associates struggling with debt. I'm going into dentistry because I think I'll be the latter, I'm in a favorable situation with debt, I'm ambitious, I do my research, I'm goal oriented.

If more females enter the profession and choose to work fewer hours and see less patients, that's even better for me because then there's more patients for me to see! Corp dentistry will make its mark, and to be honest, let them. They can gobble up the medicaid patients that typically don't profit a private practice due to low reimbursements, and meanwhile I'll target the cash paying patients, or patients with private insurance who want to go to a private practice rather than a retail setting.

I'm definitely optimistic!

This is just my guess, but I think dentistry will be more of a bimodal distribution than a regular bell curve in terms of income. Right now it's a regular bell curve, but in the future I think there will be 2 peaks, 1 at low income (associates) and 1 at high income (practice owners). There will be more low income dentists than today, and more high income dentists than today, but not as many in between. Either you succeed or you fail.

 

[ToothJockey]

Not more high income dentists than today.

My thought process behind that was that due to having an influx of associates entering dentistry, practice owners will be more financially successful than before. They have more associates available for them to hire, increase production, increase profits.

Also if you think about it, ~130 billion dollars+ will be spent on dentistry every year. That money has to go somewhere and if there are a lot more lower income dentists who are making 120k a year, then the rest of the money will be allocated towards the top. That money won't just disappear, it will go in someones pockets, and I believe those pockets will be owner dentists. Of course you can make an argument that the money will go in corporate pockets, and I don't really have a counter argument to that. But I personally don't see the corporate market share getting that large.

 

[ToothJockey]

Into the pocket of insurance companies.

Perhaps yeah

 

[charlestweed]

My parents aren't "rich", but they will help me pay for school, so I'm looking to go into ownership right away. I feel like dentistry will definitely be divided in the future, either you are struggling with debt and too scared to buy a practice, so you associate. Or you are a practice owner who is succeeding and can hire those associates struggling with debt. I'm going into dentistry because I think I'll be the latter, I'm in a favorable situation with debt, I'm ambitious, I do my research, I'm goal oriented.

For your parents to help pay for your 8 years of schooling, they must either be very rich or have made a lot of sacrifices to save for your education. This is like buying a second $400-500k house but they have to pay it in 8 years, instead 30 years.

I know this couple. The wife is a pharmacist, who works 6-7 days a week. The husband is a foreign trained dentist, who doesn't have any student loan and owns a small 2-op office. Their older daughter goes to a state dental school and their younger daughter goes to an out-of-state medical school. Even with their good income, the couple can only afford to pay for their daughters' undergrad educations + 4 years of rents in professional schools. Their 2 daughters still have to take out loans to pay for their dental and medical school tuitions.

 

[ToothJockey]

For your parents to help pay for your 8 years of schooling, they must either be very rich or have made a lot of sacrifices to save for your education. This is like buying a second $400-500k house but they have to pay it in 8 years, instead 30 years.

I know this couple. The wife is a pharmacist, who works 6-7 days a week. The husband is a foreign trained dentist, who doesn't have any student loan and owns a small 2-op office. Their older daughter goes to a state dental school and their younger daughter goes to an out-of-state medical school. Even with their good income, the couple can only afford to pay for their daughters' undergrad educations + 4 years of rents in professional schools. Their 2 daughters still have to take out loans to pay for their dental and medical school tuitions.

Made sacrifices yeah, they won't pay the full cost but a lot of it. I won't have many loans. I would like to specialize too, but that's down the road. They will continue to help me with loans. I will pay them back, to me its like I'm taking a loan from my parents, instead of the government. I'm a single child, so they've just been stacking the 529 accounts and saving for my education. They just want me to be successful, that's their #1 priority. And I will be successful, I've been busting my ass these last few years, they won't have to worry about retirement, I've got them covered.

 

[charlestweed]

......to me its like I'm taking a loan from my parents, instead of the government.

Huge difference. Your parents don't expect you to pay them back; the goverment does...and you can't file bankruptcy on the student loans. Your parents don't charge you the interest while you are in school; the government does. When you open your practice, your parents continue to lend you more money...no question asked. For the banks to approve the business loan, they usually require you to have good credit scores. Most newly grad dentists are broke and don't have good credit scores. The governement and banks don't care if your new practice is doing well or not; they expect you continue to make monthly payments ontime. Because of the abscence of the loan repayment deadlines, you can do things that your colleagues, who have student loans, can't such as taking vacations, working fewer days in a week, buying a house, driving a sport car, investing in rental properties etc.

 

[ToothJockey]

Huge difference. Your parents don't expect you to pay them back; the goverment does...and you can't file bankruptcy on the student loans. Your parents don't charge you the interest while you are in school; the government does. When you open your practice, your parents continue to lend you more money...no question asked. For the banks to approve the business loan, they usually require you to have good credit scores. Most newly grad dentists are broke and don't have good credit scores. The governement and banks don't care if your new practice is doing well or not; they expect you continue to make monthly payments ontime. Because of the abscence of the loan repayment deadlines, you can do things that your colleagues, who have student loans, can't such as taking vacations, working fewer days in a week, buying a house, driving a sport car, investing in rental properties etc.

Right, this is the only reason I am going into dentistry. If I had to pay a 400-500k student loan without my parents supporting me, I would have probably gone some other route in healthcare because it's not worth it for me. That's why I mentioned, unlike other grads I can go right into ownership. However, I won't be taking help from my parents when buying a practice, if anything, they can show the bank liquid assets so that I can get approved for a dental practice loan, but I will be paying the loan by myself.

Just because I won't have much loans doesn't mean I will be taking it easy. I'll be working my butt off, I want to earn good money when I'm still young and healthy so I can be financially independent earlier in life, and take care of my parents and myself. Like I said I want to be successful, make my parents proud, I'm no stranger to hard work, I'll do what it takes. My parents immigrated here, they had nothing at the start, I remember living in a 1 bed apartment. Now we live in a nice big house, they've worked hard to give me these opportunities. I have to make it count.

 

[Cold Front]

Truth is:

1. Associate dentists (GP or specialists) who work for more than 5-10 years will be experiencing a $300k salary ceiling (very rare to see an associate making $400k+/yr consistently) with a lot of deflationary pressures on that income over time. This may be the least headache end of dentistry, but it’s the losing end in terms of income - particularly if there is high student loans debt in play, which is the case for the majority of under age 40 dentists.

2. Practice-Owner dentists and specialists are kind of in the middle. They also have a ceiling, probably double as the associate income ceiling, $700-800k a year - but that comes with a lot of headache and a lot of responsibilities. A huge learning curve and little free time during the growth of the office period. Deflationary pressures also exist, but a lot of it will come from overhead; payroll, supplies and rent increases - while insurance reimbursement remains stagnant.

3. The business savvy dentists and specialists are on the highest level. They own more than 1 practice and other businesses that bring in significant passive income. They have thought well outside the box and took big risks to look for more income beyond dentistry. They are the least to be a prisoner in the dental profession and can choose to walk away sooner than an associate and a practice owner.

The hierarchy looks simple, but each is still very difficult from a pre-dent point of view.


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[2TH MVR]

$30-40k cheaper. The cost of the performance model S (0-60 in 2.4 seconds) was $150-160k before 2018. Now it’s only $110-120k. I bought the long range model S (0-60 in 3.7 seconds) in 2018 for $125k. Now, you can get it for $95k. The newer model X and model S are not only cheaper; they also get newer motors that help increase their ranges to 325 miles and 372 miles, respectively.

Another beauty of owning a Tesla is you don’t have to bring the car in for maintenance services for the first 2-3 years. A Tesla with 100k miles still drives like a brand new car….no engine noise/vibration…. and silky smooth acceleration. Just change the tires and you are good to go. With the saving in gasoline and maintenance cost, a $95k Telsa is cheaper than a $70k German car if you plan to keep the car for 5 years. Once you drive a Tesla, you'll never go back to a gas car....you are spoiled for life.


Edit: $25-35k cheaper because you no longer get the $7500 tax credit from the government.

Off topic, but ..... you really have to give Elon Musk cred for having the kahunies to make electric cars mainstream. In the near future .... I will convert to electric for my commuter car to get from point A to point B, but not for my fun cars. Yes electric cars are fast, but as all gearheads know .... speed is not everything. My fun cars will use petrol and I will enjoy internal combustion engines (ICE) for as long as possible. The exhaust sounds, turbo noises, blow-off waste gate noises, mechanical engine sounds, high revving naturally asperated engines, rev matching, rough shifting transmissions, etc. etc. Most sport cars today (911s, corvettes, Ferrari California, etc. etc. are actually GT cars. They're getting soft and heavy to appeal to Americans with big azzes. There's only a few REAL) sports cars (Lotus, Alfa Romeo 4C, Miata, Alpine, Toyota GT86/Subaru BRZ, etc. etc.)

There's no denying that electrification is here to stay. Even Ferrari sees this and is developing or has developed a full electric sports car for the near future.

 

[charlestweed]

Off topic, but ..... you really have to give Elon Musk cred for having the kahunies to make electric cars mainstream. In the near future .... I will convert to electric for my commuter car to get from point A to point B, but not for my fun cars. Yes electric cars are fast, but as all gearheads know .... speed is not everything. My fun cars will use petrol and I will enjoy internal combustion engines (ICE) for as long as possible. The exhaust sounds, turbo noises, blow-off waste gate noises, mechanical engine sounds, high revving naturally asperated engines, rev matching, rough shifting transmissions, etc. etc. Most sport cars today (911s, corvettes, Ferrari California, etc. etc. are actually GT cars. They're getting soft and heavy to appeal to Americans with big azzes. There's only a few REAL) sports cars (Lotus, Alfa Romeo 4C, Miata, Alpine, Toyota GT86/Subaru BRZ, etc. etc.)

There's no denying that electrification is here to stay. Even Ferrari sees this and is developing or has developed a full electric sports car for the near future.

It’s good that other luxury auto manufacturers start making fully electric cars to compete against Tesla. More competition = more choices for the consumers. Since I don’t have big enough garage space to park multiple cars, I want one car that has as many features as possible:
-Fast, safe, and reliable for everyday driving.
-Low maintenance: I don’t like wasting the whole day to bring the car to service centers for oil changes, brake pad replacements, sparkplug replacements, turing off the annoying "check engine" light etc…. get a loaner, return a loaner, and pick up the car etc. Time = money.
-Sporty and luxurious appearance.
-Zero emission: unlike the gas cars, I don’t have to leave the engine running to keep the AC on. I can be inside my car and park inside my garage with the garage door closed.
-Large cargo space so I can transport my ortho and lab instruments from one office to another…..so I can eat, sleep (laying flat with the backseat folded down) in it. There are plenty of storage spaces in both rear and front trunks. My wife’s model X has 7 seats..... It's eye-catching every time the falcon wing doors are opened and closed.
-Self-driving: with autopilot, I can read the SDN posts while driving home in a bumper-to-bumper traffic with my legs crossed and my arms stretched above my head. While the kids have piano/tennis lesson, I can watch a football game. I like the versatility of the car’s 17 inch monitor.

 

[Cold Front]

I will get an electric car in 12-18 months. The supply chain and waitlist for them is insane now, specially at Tesla. In the meantime, I might look into getting the new Porsche 911-992. I grew up driving a manual transmission in England, and I wish I lived in Norther Cali to drive that car every Sunday at the pacific coast highway. From the Bay Area to Monterey. The last time I drove through those scenic roads, a group of 12-14 911’s drove past me - probably a local 911 club.

Anyways, it feels like -10F here this evening. Can’t wait for spring.



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[Cold Front]

Off topic, but ..... you really have to give Elon Musk cred for having the kahunies to make electric cars mainstream.

I’m going to make a wild and bold prediction... that Elon Musk will be nominated and possibly win a Nobel Peace Prize for playing a crucial role in the electric car industry, possibly as early as next decade - when all big auto manufacturers sales of electric cars outpace their internal combustion cars. Which I think will happen. Europe is already leading the growth in electric cars, I think the US is always behind on consumers adapting to new technology - just like Europe and Asia cell phone industry has always been ahead of their US counterparts, at the consumer level.



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[DrJeff]

I’m going to make a wild and bold prediction... that Elon Musk will be nominated and possibly win a Nobel Peace Prize for playing a crucial role in the electric car industry, possibly as early as next decade - when all big auto manufacturers sales of electric cars outpace their internal combustion cars. Which I think will happen. Europe is already leading the growth in electric cars, I think the US is always behind on consumers adapting to new technology - just like Europe and Asia cell phone industry has always been ahead of their US counterparts, at the consumer level.



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Anyone, who can without any real details, or set delivery date, get the market to give his company in essence an interest free 25 million dollar loan, as happened with the pre-order $100 fee for the cybertruck (the $100 reservation fee times the reported 250k folks who plunked down the $100 fee), even if he ends up refunding a bunch of those "reservation fees" is some marketing genius that most all of us could desire to achieve!

 

[Cold Front]

Anyone, who can without any real details, or set delivery date, get the market to give his company in essence an interest free 25 million dollar loan, as happened with the pre-order $100 fee for the cybertruck (the $100 reservation fee times the reported 250k folks who plunked down the $100 fee), even if he ends up refunding a bunch of those "reservation fees" is some marketing genius that most all of us could desire to achieve!

Yes. He is selling an idea/dream to the masses. It will only be understood from a historical perspective. If the cybertruck had any other badge other than Tesla’s, it would not create as much hype - because he leveraged the success of model S and 3 on all future models - even if they are extremely unconventional. Just like Apple did with many of their defunct products that created a lot of hype when they were introduced.


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