AMA: Graduated 2021, did a GPR, now working with $200k/year minimum 4 days per week in private practice in a mid-size city.

[Roy Williams]

(accidentally posted this in the pre-dent thread first and do not know how to delete it)

AMA about dental school, residency, job search, procedures, finances, loans, etc. I'll answer everything with the caveat of no information that will help to identify me personally.

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[NavyBlueSuit]

What issues have caused you and your classmates the most trouble since graduating dental school? Did you feel like you came out of the gpr with a better skillset than a dental grad that worked for a year instead?

 

[Roy Williams]

What issues have caused you and your classmates the most trouble since graduating dental school? Did you feel like you came out of the gpr with a better skillset than a dental grad that worked for a year instead?

I'll be honest, I have not had any issues and neither have the majority of my friends (whether they went straight out from dental school or did a residency first). I had no problem getting a job, had plenty of great offers. Same with the majority of my friends. Of those that I've heard that have had issues are the ones that pretty vocally did not enjoy dentistry in and of itself and also started working immediately for DSO type practices. Some of them have bounced around to 2-3 jobs already or are temping.

And yes 100%. I feel I am years ahead of those that graduated with no residency.

 

[dentalinthemental]

How did you choose which GPR to attend & what new skills (ex: endo, implants, sedation, advanced prosth) did you find the most profitable/relevant in practice?

 

[Roy Williams]

How did you choose which GPR to attend & what new skills (ex: endo, implants, sedation, advanced prosth) did you find the most profitable/relevant in practice?

I was specifically looking for a surgery heavy GPR that focused on sedation and implants. I was lucky that I also got experience with advanced prosth.

 

[2TH MVR]

Do you feel a good GPR is better than a good AEGD. I guess I'm curious why people choose one over the other.

 

[Chief's Pineapple]

I'm assuming you're currently associating, not an owner? If so, do you plan to partner or buy in the future?

How did you land in your current position (Indeed, word of mouth, etc.)?

What kind of procedures do you usually do on a day-to-day basis? What's your payer mix?

 

[Roy Williams]

Do you feel a good GPR is better than a good AEGD. I guess I'm curious why people choose one over the other.

I applied to both GPRs and AEGD programs. I didn't care as much about which one I was going to. I was moreso looking for programs that had exactly what taught the skills I was hoping to learn. I think there are great AEGD programs and GPR programs out there. I turned down an AEGD program that people here on SDN seem to laud over as being the best program in the country, but it just wasn't what I was looking for. That said, it is still an amazing program. It is just hard to figure out which is which without hours of reading stories from people online and actually interviewing at these places and talking to previous residents.

 

[Roy Williams]

I'm assuming you're currently associating, not an owner? If so, do you plan to partner or buy in the future?

How did you land in your current position (Indeed, word of mouth, etc.)?

What kind of procedures do you usually do on a day-to-day basis? What's your payer mix?

Yeah currently an associate. I signed a three year job contract as the two owners of the practice were not comfortable guaranteeing my minimum as well as buying all the necessary supplies for implants and sedation if I were only to sign a one year contract. So my goal is to work as an associate for three years to get my speed up, continue to learn, understand the private practice model and then most likely transition to an owner after that time. Whether here or elsewhere, I'm not sure.

I applied through Indeed and Dental town for jobs.

It is surgery heavy but little bit of everything. I don't do any endo. Implants for single unit crowns and overdentures. I restored a few hybrids in residency but don't want to tackle that in private practice yet until I take another CE course to hone down the digital workflow (I only know how to do it analog). Lots of extractions and socket preservation. Sinus lifts. And then crown and bridge as well.

 

[Chief's Pineapple]

It is just hard to figure out which is which without hours of reading stories from people online and actually interviewing at these places and talking to previous residents.

Were you able to get in contact with the previous residents of the programs you were interested in?

 

[Roy Williams]

Were you able to get in contact with the previous residents of the programs you were interested in?

Yeah I usually got a few contacts when I did interviews and then reached out with questions afterwards.

 

[Teeth and Titanite]

And yes 100%. I feel I am years ahead of those that graduated with no residency.

I am curious about how GPRs can be so effective. How busy was your program? How many patients a day vs. your dental school?

 

[Roy Williams]

I am curious about how GPRs can be so effective. How busy was your program? How many patients a day vs. your dental school?

It is totally dependent on the program. There are tons of terrible programs out there I would never consider going to. But also many that are 100% worth it. I can't speak to the experience of others but in my year I had over 100 sedations that I did, placed 70 implants, did 12 lateral window sinus lifts, bunch of sinus bumps, lots of experience with membranes and different suture types and grafting, restored one hybrid, couple overdentures, probably did 80-100 units of crown and bridge including two esthetic cases putting patient in esthetic temps first and one full mouth rehab opening VDO. Did 2 root canals lol.

 

[Teeth and Titanite]

It is totally dependent on the program. There are tons of terrible programs out there I would never consider going to. But also many that are 100% worth it. I can't speak to the experience of others but in my year I had over 100 sedations that I did, placed 70 implants, did 12 lateral window sinus lifts, bunch of sinus bumps, lots of experience with membranes and different suture types and grafting, restored one hybrid, couple overdentures, probably did 80-100 units of crown and bridge including two esthetic cases putting patient in esthetic temps first and one full mouth rehab opening VDO. Did 2 root canals lol.

Wow that sounds like a brilliant program! One more follow up question: what is the competition like for a GPR/AEGD like this one? What things can help you be successful when applying (class rank, clubs, etc.)?

 

[2thDoc11]

(accidentally posted this in the pre-dent thread first and do not know how to delete it)

AMA about dental school, residency, job search, procedures, finances, loans, etc. I'll answer everything with the caveat of no information that will help to identify me personally.

What did your loans look like after dental school? If you can answer, which school did you attend? Any idea what what a general range of new job offers are and/or what classmates were being offered? Financial situation is a big topic now-a-days and it’s hard to get a good read on it from someone as fresh if of school as you. What’s the general population of a city where you can still do well early on in your career without all the saturation? Thanks!

 

[Roy Williams]

Wow that sounds like a brilliant program! One more follow up question: what is the competition like for a GPR/AEGD like this one? What things can help you be successful when applying (class rank, clubs, etc.)?

It is pretty high. Totally subjective but I think just as high as certain specialties. I was in the top of my class (idk exactly where we only ranked in quartiles but my gpa was a 3.92) and got interviews to most of the programs I applied to which was around 10 or so. I had classmates that applied to a lot of the same ones and only got 1-2 interviews. One of the programs I interviewed at gave a "day before the interview" meeting thing over zoom with all the interview candidates over the next few days and mentioned that the only people that got interviews of the hundreds that applied were in the top of their class (most of this was done over zoom when I was interviewing because of covid). Clubs don't matter at all. Do them if you want to but that's going to have no bearing on getting into a residency program.

 

[Roy Williams]

What did your loans look like after dental school? If you can answer, which school did you attend? Any idea what what a general range of new job offers are and/or what classmates were being offered? Financial situation is a big topic now-a-days and it’s hard to get a good read on it from someone as fresh if of school as you. What’s the general population of a city where you can still do well early on in your career without all the saturation? Thanks!

I think I finished with $207k in loans. I had about $20k saved up from my gap year that I spent on living expenses throughout the first year of dental school so that helped a bit. I went to a public in state school so that also helped with tuition costs. I still went on vacations and had fun; I wasn't necessarily penny pinching throughout dental school. I kinda figured that an extra $5k or so over four years is not going to have an effect on my life in the long run and if it allowed me to enjoy my time more then it was worth it to me.

I refinanced my loans during my residency program through laurel road. I made a spreadsheet and figured out what was best for me and ended up deciding on a 20 year repayment program where I will pay about $1250/month over the next 20 years which is more than doable and now I never have to worry about my loans anymore. I can go more into why I chose this plan if people want.

Classmates out of dental school I'm not sure. I know two that made over $300k their first year out just working normal jobs and doing bread and butter dentistry. Others are probably less. Most of my close friends went into residencies. The specialty ones are still in residency obviously. Of the ones that did AEGD/GPR programs that I am close with (most were pretty decent programs) I would be surprised if anybody takes home less than $200k in their first year out (before taxes). I'm in a city with a population between 700k-1M people.

 

[drt$]

I was specifically looking for a surgery heavy GPR that focused on sedation and implants. I was lucky that I also got experience with advanced prosth.

what GPR did you attend? That covers pretty much everything I am interested in gaining from a GPR, but I have had trouble figuring out which programs offer a lot of prosth work.

 

[schmoob]

Sounds like a fantastic program that you went to, congratulations on finishing such a great program!
Correct me if I’m wrong, you’re doing IV Sedations? And the owners invested in all the equipment necessary to do this? How did your malpractice premiums jump? And are you doing procedures alone or do you have a paramedic with you during sedations?

 

[Roy Williams]

what GPR did you attend? That covers pretty much everything I am interested in gaining from a GPR, but I have had trouble figuring out which programs offer a lot of prosth work.

I can't say specifically which I went to for anonymity reasons. However there are plenty of threads out there on SDN talking about solid gpr and aegd programs. You won't really get a feel for the program without actually going and visiting and interviewing. I interviewed at some that were listed here that I just didn't like. That isn't to say they are bad programs, just not right for me. Everyone had a different experience so it is worth exploring as many as possible.

 

[Roy Williams]

Yeah that is correct. The owners invested in all the equipment necessary to get sedation and implants going. Also I'm not sure about the malpractice premium as I worked that into my contract so I am not the one paying for it. But that's also why we signed a 3 year contract. They wouldn't commit to investing in those equipment parts without guaranteeing a 3 year commitment.

No paramedics, but they also hired one of my coresidents so there will be two of us present at all times in the office when sedations are happening. We didn't have these restrictions in residency but we made them for ourself mainly for the safety of our patients where we won't sedate anybody outside the age range of 17-65, ASA I or very well controlled ASA II.

 

[D1Bound]

Yeah that is correct. The owners invested in all the equipment necessary to get sedation and implants going. Also I'm not sure about the malpractice premium as I worked that into my contract so I am not the one paying for it. But that's also why we signed a 3 year contract. They wouldn't commit to investing in those equipment parts without guaranteeing a 3 year commitment.

No paramedics, but they also hired one of my coresidents so there will be two of us present at all times in the office when sedations are happening. We didn't have these restrictions in residency but we made them for ourself mainly for the safety of our patients where we won't sedate anybody outside the age range of 17-65, ASA I or very well controlled ASA II.

How does an anesthesia permit work? I don’t quite understand the legality of what you are referring to as “sedation.” I’ve read for 1 state that it’s OMS and dental anesthesiologists who get to do deep sedation/general anesthesia and no one else.

 

[Roy Williams]

How does an anesthesia permit work? I don’t quite understand the legality of what you are referring to as “sedation.” I’ve read for 1 state that it’s OMS and dental anesthesiologists who get to do deep sedation/general anesthesia and no one else.

Perio residencies and certain GPR residencies train in sedation as well. But I am only trained in moderate/conscious sedation, not deep or general like omfs. I do not use propofol or ketamine, only versed and fentanyl. In my program I personally sedated around 120 patients throughout the year. There are CE classes people can take to get sedation certified but I think those are pretty dangerous where they cram 15-20 sedations into a weekend. I didn't feel like I really had a grasp on how things really worked until about my 50th. And it wasn't until around 80-90 where I actually started feeling comfortable enough where I could do it on my own without faculty around.

 

[D1Bound]

Perio residencies and certain GPR residencies train in sedation as well. But I am only trained in moderate/conscious sedation, not deep or general like omfs. I do not use propofol or ketamine, only versed and fentanyl. In my program I personally sedated around 120 patients throughout the year. There are CE classes people can take to get sedation certified but I think those are pretty dangerous where they cram 15-20 sedations into a weekend. I didn't feel like I really had a grasp on how things really worked until about my 50th. And it wasn't until around 80-90 where I actually started feeling comfortable enough where I could do it on my own without faculty around.

What life saving abilities did you learn for patients?

 

[Roy Williams]

What life saving abilities did you learn for patients?

• I think most important skill needed to sedate patients is carefully screening at pre-procedural appointments going through a comprehensive medical history. Case selection is extremely important. You will significantly decrease the risk for a having a medical emergency by carefully choosing which patients to sedate. I know my limitations and have no problem referring something I don't feel comfortable with. Obviously medical emergencies are still possible, but in my opinion this planning step is the most vital part of reducing the risk for these emergencies.
• Understanding what is and isn't a medical emergency and how to react to it
• Understanding when something is out of my skill level or heading towards being out of my skill level where 911 needs to be called.
• Venipuncture, drawing up drugs, and starting IVs in order to administer emergency drugs
• Dosing reversal drugs for the medications we use for sedation.
• Maintaining a patent airway through head tilt chin lift, oral airways, LMA devices, or nasal airways with bag/valve/mask in order to deliver positive pressure oxygen.
• Management of different emergencies like hypotension, bradycardia, malignant hypertension, respiratory depression, asthma attacks, syncope, laryngospasm, allergic reactions, anaphylaxis, cardiac arrest, etc.

Sitting on a plane rn and just wrote that up quickly so that is not an exhaustive list.

 

[dentalchamp98]

Would you go back and do dentistry knowing what you know now? I’m a D3 and personally dreading dental school at the moment, questioning my decisions

 

[Roy Williams]

Would you go back and do dentistry knowing what you know now? I’m a D3 and personally dreading dental school at the moment, questioning my decisions

100%. But I also really enjoyed dental school. Had good relationships with faculty and made some of the best friends of my life.

 

[New_england]

When and how did you rule out doing specialty residencies? Just wondering since your gpa is high

 

[Chief's Pineapple]

When and how did you rule out doing specialty residencies? Just wondering since your gpa is high

Are you implying that people who have high GPA's and/or high class rank and DON'T specialize are out of the norm?

 

[New_england]

Are you implying that people who have high GPA's and/or high class rank and DON'T specialize are out of the norm?

Thought it’s more common for them to specialize

 

[christiansn]

I think I finished with $207k in loans. I had about $20k saved up from my gap year that I spent on living expenses throughout the first year of dental school so that helped a bit. I went to a public in state school so that also helped with tuition costs. I still went on vacations and had fun; I wasn't necessarily penny pinching throughout dental school. I kinda figured that an extra $5k or so over four years is not going to have an effect on my life in the long run and if it allowed me to enjoy my time more then it was worth it to me.

I refinanced my loans during my residency program through laurel road. I made a spreadsheet and figured out what was best for me and ended up deciding on a 20 year repayment program where I will pay about $1250/month over the next 20 years which is more than doable and now I never have to worry about my loans anymore. I can go more into why I chose this plan if people want.

Classmates out of dental school I'm not sure. I know two that made over $300k their first year out just working normal jobs and doing bread and butter dentistry. Others are probably less. Most of my close friends went into residencies. The specialty ones are still in residency obviously. Of the ones that did AEGD/GPR programs that I am close with (most were pretty decent programs) I would be surprised if anybody takes home less than $200k in their first year out (before taxes). I'm in a city with a population between 700k-1M people.

Hey, loving this AMA thread! Could you elaborate on why you chose a 20 year plan?

 

[Chief's Pineapple]

Thought it’s more common for them to specialize

Perhaps it's because some want to specialize, and realize they have to have the grades for it, and THEN they go and achieve high grades? Instead of getting high grades and then thinking "oh, you know...I can't just be a peasant GP, I have to specialize, I do have high grades after all"? You just made it sound like being a GP/not having high grades isn't "optimal", per se, that's all.

 

[dentalinthemental]

Thought it’s more common for them to specialize

Soo many of the top ranking people in my class are doing general lol. A lot of people find specialties kind of boring, it's really not for everyone and you have to love it

 

[somefuturedoc]

Soo many of the top ranking people in my class are doing general lol. A lot of people find specialties kind of boring, it's really not for everyone and you have to love it

Yeah def depends on the school. Mines the opposite

 

[Roy Williams]

When and how did you rule out doing specialty residencies? Just wondering since your gpa is high

On a vacation 3rd year of dental school when I was in Scotland with some friends realizing I enjoyed doing things outside of dentistry too much.

 

[Roy Williams]

Hey, loving this AMA thread! Could you elaborate on why you chose a 20 year plan?

I made a spreadsheet that calculated my loan repayments based on the different year plans that were offered to me. And then the differences in the monthly payments depending which I did. Yeah I can pay off my loans faster if I choose a quicker plan, but over a 20 year period I come out ahead with the 20 year plan (by investing what I'm saving on the lower monthly payments at that time). Let me know if you want me to explain that spreadsheet a bit more.

 

[2thDoc11]

I made a spreadsheet that calculated my loan repayments based on the different year plans that were offered to me. And then the differences in the monthly payments depending which I did. Yeah I can pay off my loans faster if I choose a quicker plan, but over a 20 year period I come out ahead with the 20 year plan (by investing what I'm saving on the lower monthly payments at that time). Let me know if you want me to explain that spreadsheet a bit more.

Kinda back to the finances, I’m looking at roughly $300k in student loans max hopefully. Looking to borrow ~$260k but with interest and what ever else I’ll overestimate. I’ve tried to be optimistic and have the mentality of trying to pay it off as quick as possible once I’m working. If you don’t mind, can you break down the monthly expenses and what’s left over? A lot of dentists on SDN say that dentistry isn’t financially worth it and after you pay your rent/mortgage, insurances, groceries, bills and loan there’s not much left to live on. Hows it been for you I’m that regard

 

[Roy Williams]

Kinda back to the finances, I’m looking at roughly $300k in student loans max hopefully. Looking to borrow ~$260k but with interest and what ever else I’ll overestimate. I’ve tried to be optimistic and have the mentality of trying to pay it off as quick as possible once I’m working. If you don’t mind, can you break down the monthly expenses and what’s left over? A lot of dentists on SDN say that dentistry isn’t financially worth it and after you pay your rent/mortgage, insurances, groceries, bills and loan there’s not much left to live on. Hows it been for you I’m that regard

Sure, I currently have more money than I know that to do with. I've only been working for about two months right now and still building up my schedule so I'm currently taking home my minimum but am expecting to start outproducing that by December. With my minimum my monthly take home after taxes is about $12k. And like I mentioned, I refinanced my loans so that I am just paying a monthly book for the next 20 years and it's no longer something I need to worry about. I am also currently late 20s and single with no kids. So that helps. I also plan on buying a place within the next year so that I'm not throwing money away at rent and it'll be more of an investment. My disability insurance was about $1300 I think paid as a yearly premium, so that's not in my monthly budget.

Loan payment: $1300
Rent: $2200
Utilities and internet: $110
Pet food/toys/treats: $45
Car payment: $180
Health insurance (this will go away once I work for 90 days and my benefits start): $140
Car/umbrella insurance: i honestly forget how much im paying for this. Around $180 maybe? No idea

So all that comes out to be $4155. That leaves me with $7845 to do whatever I want with. I usually spend around $5-700 on groceries and going out for food and drinks throughout the month. Currently building up my Emergency fund in a high yield savings account. Once I get that to $20k I'll start investing the rest of what I don't spend into index funds and maxing out my 401k.

 

[zToothinator]

Who do you recommend connecting with to build your "team" (financial planners, disability insurance agents, malpractice insurance agents, dental lawyers, etc)?

 

[Roy Williams]

Who do you recommend connecting with to build your "team" (financial planners, disability insurance agents, malpractice insurance agents, dental lawyers, etc)?

Tbh I found my lawyer through a reddit comment on the dental sub. Turned out great he was the man. A few of my other coresidents used him too and we all have nothing but positive things to say. He saved one of my friends from taking a terrible job with a super sketchy contract.

I personally don't think I will use a financial planner for investments (at least at this time in my life). See no reason why you can't just put the majority of your money into 1-3 index funds and let it sit until retirement. I did use a finance group to help me with my disaiblity insurance and just through them bought the Principal policy. It was a group that took our resident class out to dinner.

Malpractice i went with what my practice paid for (Cincinnati)

 

[AONLINE]

@Roy Williams Which geographic area are you located in (e.g. Midwest, Northeast or West Coast?)
Are you living in a state with high income tax?

 

[gsparrow]

It is totally dependent on the program. There are tons of terrible programs out there I would never consider going to. But also many that are 100% worth it. I can't speak to the experience of others but in my year I had over 100 sedations that I did, placed 70 implants, did 12 lateral window sinus lifts, bunch of sinus bumps, lots of experience with membranes and different suture types and grafting, restored one hybrid, couple overdentures, probably did 80-100 units of crown and bridge including two esthetic cases putting patient in esthetic temps first and one full mouth rehab opening VDO. Did 2 root canals lol.

What gpr did u go to.
im looking for implant heavy and sedation heavy experience in a residency program. Please advise where I can apply to in the coming cycle. Also how do u get in touch with VA clinics

 

[zToothinator]

What gpr did u go to.
im looking for implant heavy and sedation heavy experience in a residency program. Please advise where I can apply to in the coming cycle. Also how do u get in touch with VA clinics

Email the program directors directly
VA.gov | Veterans Affairs