Another New Orthodontist Graduates with $1M+ in Student Loans

[Cold Front]

For anyone considering ortho in the future.

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[deleted547631]

For anyone considering ortho in the future.

LOL! Dentistry is a complete sh**show these days. Over $5000 per month in INTEREST. We have a great problem in this country and this young orthodontist is the poster child of a broken system.

 

[2TH MVR]

Why o why does it always have to be an orthodontist. At least the orthodontist is working 6 days a week and started his own practice.

 

[Cold Front]

Because it’s probably more sensationalist. If it were a periodontist or endodontist the general public wouldn’t understand as readily as an orthodontist I suppose.

I am saddened by the thousands of general dentists that decided not to specialize in their specialty of choice because they found the return on investment or risk not worth it. Only the rich will be able to specialize soon.

I think we will see new grads with $1.5M in student loans in our lifetime... thanks to tuition going up every year and compounding interest. Probably in 15 years for sure.


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[Cold Front]

Why o why does it always have to be an orthodontist. At least the orthodontist is working 6 days a week and started his own practice.

So that debt level is sustainable by that new grad in your opinion?


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[Cold Front]

LOL! Dentistry is a complete sh**show these days. Over $5000 per month in INTEREST. We have a great problem in this country and this young orthodontist is the poster child of a broken system.

You can tell by his voice during the interview - that he feels the weight of the situation he got himself in. I mean - to be on that show, you have to be somewhat lost to know your options with that kind of debt.


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[Svart Aske]

Only the rich will be able to specialize soon.

The rich and the deeply indebted.

 

[deleted903013]

It's amazing this system is allowed to be in place. No education should cost 1 million dollars, not even half a million dollars. My heart goes out to those suffering from this. The education bubble has to burst eventually.

 

[Cold Front]

Definitely not for sure. I have the hope future students are close enough to reality to understand 1.5 million in debt To become a specialist is poor judgment.

If you think about it, schools have been raising their tuition 3-4% (at the low end) every year for the past 15 years. So if the are people graduating today with $1M in student loans, all it takes is another 9-10 more years with 3-4% tuition increases (and compounding interest) from that $1M to get to $1.5M. So I predict some junior undergrad student today who wants to attend dental school and specialize after - a total of 9 years, could come out with $1.5M debt. $1M debt was unimaginable 9 years ago, but here we are talking about few people who did. The cost of attendance and the compounding interest both balloon faster together at higher debt levels.


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[Cold Front]

It's amazing this system is allowed to be in place. No education should cost 1 million dollars, not even half a million dollars. My heart goes out to those suffering from this. The education bubble has to burst eventually.

Surprisingly - most people would agree with you, but there are powerful special interest groups that have lobbied for this problem to persist with the government’s support. It’s the same reason why our current government has passed permanent tax cuts for corporations, but everyone else gets tax cuts for few years. All we can do is watch the student loans crisis get much worse every year until we see the bubble burst.


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[charlestweed]

A hard working responsible person will never let this happen. One shouldn’t owe any money for his/her undergrad education if he/she is willing to attend a local university and lives with the parents. If he/she is poor, the government will offer some grants. If he/she is from the middle income family, his/her parents should be able to pay for his/her undergrad education. If he/she works hard and stays focused in school, he/she should have much higher chance of getting accepted to a cheap state dental school…and eventually to an ortho program that offers stipend.

 

[charlestweed]

Making $200-250k/year for working only 3 days/week is not bad at all for this new grad ortho, who has zero experience. To me, this is easy money. I was not wrong when I said ortho is an overpaid specialty. For a new grad general dentist to make that much, he/she would have to work 5-6 days/week. It is, however, a big waste of time for this new grad orthodontist to spend 3 days/week working at his own 2-month old office, which probably only has around 10-15 active patients. One day/week (or 4 days/month) is more than enough. This orthodontist needs to double his current $200-250k salary by finding another 2-2.5 days/week associate job at a corp. If he can’t find another ortho job, the worst case scenario is he can work as a GP 2-2.5 days/week…or drive an Uber car 2-2.5 days/week. Dave Ramsey is a wrong person to ask because he doesn’t know how orthodontists book their patients and how they make money. He should ask some veteran orthodontists like 2thMVR. Imagine if this new grad ortho can bring home an additional $100-150k/year ($350-400k/year total income), paying back his $1mil student loan shouldn’t be too bad.

I hope in addition to working in the front, his fiancé also knows how to do chairside assisting (ie changing wires, taking impressions etc) so he doesn’t need to hire an assistant. The office is only 2 months old. There should be plenty of free time for this couple to find other jobs to make more than what they make now. It's unproductive sitting around doing nothing 3 days/week.

 

[charlestweed]

Board certified orthodontists can work as general dentists? I thought specialists renounced the privilege of practicing as a general dentist when becoming board certified in any specialty.

Here in CA (and in many other states), there is no separate specialty license for orthodontist. I have the same dental license that the GPs have. So I can extract teeth and do fillings if I want to. I know in certain states (ie Kentucky), there is a specialty license and you can’t go back to practicing general dentistry if you are a specialist.

 

[Cold Front]

Imagine if this new grad ortho can bring home an additional $100-150k/year ($350-400k/year total income), paying back his $1mil student loan shouldn’t be too bad.

Actually, it would still be bad. That additional $100-150k income would be pre-tax income. So it would be closer to $60-100k for post-tax (additional $5-8k a month). That would not put a lot of dent to his $1M debt - which as he said needs $5-6k a month in interest alone. That’s a lot of fire to put out... not to mention his new office debt, if he has a mortgage, auto loans, credit card debts, and the cost of his lifestyle. You could probably get around $1M debt with $400k a year income, but I would guess 90% of your peers would not - because of their personal finances would not be as strict as yours. Ultimately, stagnant Ortho service fees will never keep up with the rising tuition (and compounding interest). Student loans almost doubled the past 10 years, while ortho fees pretty much stayed the same - and that trend will continue every year for the foreseeable future. That’s the bottom line.


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[DrJeff]

I think we will see new grads with $1.5M in student loans in our lifetime... thanks to tuition going up every year and compounding interest. Probably in 15 years for sure.



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I'm guessing that is you take the "dental school couple" situation that I'm sure we all know does happen (heck I FULLY resemble that remark 😀 ) that we already have couples who are at/past that 1.5 million in debt mark

I do remember, about 5 years ago when I was much more actively involved in the world of dental politics than I am currently, there was a resident, who was in her 1st year of the perio program at Harvard, who was telling those of us in attendance at our ADA District Caucus meeting, the situation her and her fiancee were in (her fiancee was a 4th year student still at that point). They both went to USC for their dental school, she was doing the perio program at Harvard, he had been accepted into the OMFS program there. When they finished up their residencies, they were going to have roughly 1.2 million in loan debt. The room our caucus was being held in went silent.

I honestly wish that anyone, regardless of how big or small the amount of college loans they're taking out is, took to heart what to me was the most important bit of advice that Dave Ramsey gave in that clip, and that was when he talked about living like "your a poor college student" until that debt has been taken care of. That's truly some sage advice, as far too often, even with much smaller educational loan debts, folks feel the need to "reward" themselves for completing their education and take on more significant debt via other things and then struggle for a long time to get the debt under control. And unfortunately some never get the debt under control.

Make no doubt about it, education IS a BIG business. There are far too many people who don't understand this. That is a problem

 

[2TH MVR]

I honestly wish that anyone, regardless of how big or small the amount of college loans they're taking out is, took to heart what to me was the most important bit of advice that Dave Ramsey gave in that clip, and that was when he talked about living like "your a poor college student" until that debt has been taken care of.

I agree with the advice, but the reality is that the students in these situations (high DS debt) apparently had no financial sense to begin with. Now to suggest to them to act like a poor college student is not going to be appealing to these new dentists. They've toiled for many years and now they are just starting to make some money. Human nature will take over and they will make more financial mistakes. It's easy for us "mature" dentists to make these suggestions (live like a poor student) but in real life .... I imagine it will be more difficult to be financially fiscal with all their decisions. Some get it. Others don't.

Ultimately, stagnant Ortho service fees will never keep up with the rising tuition (and compounding interest). Student loans almost doubled the past 10 years, while ortho fees pretty much stayed the same - and that trend will continue every year for the foreseeable future. That’s the bottom line.

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I unfortunately agree with this statement. Ortho fees are stagnant and it doesn't seem to be getting any better. There's a Corp office just down the road from my place of employment that is offering a Black Friday Special. Braces for $2100.

I suggested this before that everything is cyclical. Supply and demand. At some point (maybe now) in the near future ..... PAYING large sums of money to be an orthodontist will not be worth it. Fewer students wanting to go into ortho means: fewer ortho "for profit" schools and ultimately fewer dentists wanting to be orthodontists. Fewer orthodontists .... less saturation.

 

[Svart Aske]

I do remember, about 5 years ago when I was much more actively involved in the world of dental politics than I am currently, there was a resident, who was in her 1st year of the perio program at Harvard, who was telling those of us in attendance at our ADA District Caucus meeting, the situation her and her fiancee were in (her fiancee was a 4th year student still at that point). They both went to USC for their dental school, she was doing the perio program at Harvard, he had been accepted into the OMFS program there. When they finished up their residencies, they were going to have roughly 1.2 million in loan debt. The room our caucus was being held in went silent.

A relatively productive new grad OMFS/Perio couple can presumably make $600K+/year combined. If they live reasonably frugally that $1.2 mil debt can be eliminated under 5 years. It's the individual GP/perio/prosth new grads with >$400K loan that are going to struggle.

 

[Cold Front]

I wonder how many of today’s new grads with $500k+ debt would recommend dental school to a pre-dent? I certainly wouldn’t at any number with 5 or higher in front of it.



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[mmc12]

I suggested this before that everything is cyclical. Supply and demand. At some point (maybe now) in the near future ..... PAYING large sums of money to be an orthodontist will not be worth it. Fewer students wanting to go into ortho means: fewer ortho "for profit" schools and ultimately fewer dentists wanting to be orthodontists. Fewer orthodontists .... less saturation.

At what debt number would pursuing a career in orthodontics not be worth it and fewer applicants would keep applying? As far as I know, ortho programs now are still receiving increasing number of applications each year even with increasing tuition.

 

[Anondds87]

I cant see ortho applications decreasing to the point that ortho programs have to shut down and the number of orthos decreases any time soon. The same with dental school applicants - there will always be those who have no information about the profession thinking it's a once in a lifetime opportunity. Firstly there would be a phase where the competitiveness decreases to a point where applicants dont have to be very impressive to get a spot - and suddenly a bunch of average students have the opportunity to become a dentist or orthodontist? They will jump at it. Programs wont close down.

I think a big issue is so many people talk the professions up too much. And it's hard to be honest without sounding miserable or unprofessional. But at the end of the day this is a job, you shouldn't commit to a lifetime of debt for a job - whose sole purpose is to make you money. People need to be told at some point the profession isnt worth it.

For me, that number is 200k debt for a dentist and 300k for ortho. Higher than that you're better off in another field.

 

[Cold Front]

For me, that number is 200k debt for a dentist and 300k for ortho. Higher than that you're better off in another field.

So basically - almost 90% of pre-dents applying this cycle should consider another profession because their student loans will be over $200k? And almost all ortho applicants already have over $300k in students loans.




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[charlestweed]

I cant see ortho applications decreasing to the point that ortho programs have to shut down and the number of orthos decreases any time soon. The same with dental school applicants - there will always be those who have no information about the profession thinking it's a once in a lifetime opportunity. Firstly there would be a phase where the competitiveness decreases to a point where applicants dont have to be very impressive to get a spot - and suddenly a bunch of average students have the opportunity to become a dentist or orthodontist? They will jump at it. Programs wont close down.

I don’t expect this trend (the decrease in the number of applications) to happen in the near future either. Ortho income and job availability started to decline in 2007-2008, during the housing bubble years. Now, 11-12 years later, most ortho programs continue to raise their tuitions and they don't have any problem filling all the spots with highly qualified candidates. In fact, today ortho applicants have much better academic stats than the past candidates (like me), who applied 15-20 years ago. As soon as there were opening spots on the match day, they all got filled right away. Many expensive 2-year programs like NYU and Tufts increased the training length to 3 years (to make more money) and yet, they have had no problem finding the top ranked dental students to fill the spots. Being rich and willing to pay big bucks for an orthodontic residency are not enough (unless you are the son or daughter of a rich famous orthodontist). One has to have good academic stats as well.

 

[charlestweed]

I wonder how many of today’s new grads with $500k+ debt would recommend dental school to a pre-dent? I certainly wouldn’t at any number with 5 or higher in front of it.



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You also owed a lot in student loan and you have done very well as a general dentist….much better than me…..and I graduated many years before you. I know the amount of student loan you owed was less than $500k. But do you think you, yourself, could still make as much as what you make now if you were today new grad with 500k debt?

 

[Cold Front]

Being rich and willing to pay big bucks for an orthodontic residency are not enough (unless you are the son or daughter of a rich famous orthodontist). One has to have good academic stats as well.

I read somewhere/heard from actual residents that somewhere between 40-50% of ortho and Endo program residents got in through connections, and much less to do with their academic performance. I personally know an Endo resident who was close to the bottom of his class and got into residency through a connection.

Also, lot of dental school and residency faculties help their kids get into residency programs at the schools they teach - and those kids will always have better odds of getting into those programs than many stronger applicants that no one from the school heard of. So many seats in ortho and Endo programs are called “legacy seats” - and even alumni who donated a lot of money to the school or foreign countries who send a lot of their foreign dentists to some private schools qualify for those seats. So ortho is getting more competitive for those reasons more than just academic stats, because the legacy seats candidates have strong financial backing (or the cost is less of a factor than getting in through someone they know) - which encourages the ortho residency programs to keep raising the tuition every year because half the class/legacy candidates will pay at all cost, and the rest are plenty of highly competitive candidates fighting for those seats. Even if more ortho schools open, they too will charge high tuitions like the rest and fill their classes the same way. Yet, ortho in the real world is still hard work and no guarantees that any orthodontist will be financially making bank (unless their parents were already well established orthodontists - the legacy route).



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[Cold Front]

You also owed a lot in student loan and you have done very well as a general dentist….much better than me…..and I graduated many years before you. I know the amount of student loan you owed was less than $500k. But do you think you, yourself, could still make as much as what you make now if you were today new grad with 500k debt?

I graduated 9 years ago. I owed $280k (I could have owed closer to $200k - but that’s another story). I was very very very lucky over the years to move quickly from associateship and make financial decisions that helped me own practices and other investments. Because psychologically, $280k was a small number in my mind at the time (and it still is to others in today’s view of student loans). If I had $500k+ in student loans today, I would not be as in a hurry as I was 9 years ago - psychologically, my decision making process in investing more in myself through more debt (through practices and real estate) would be more conservative for sure. Maybe I would build smaller size dental offices, or at a different part of town/city, or whatever the $500k+ student loans (with just a diploma in my hand) pressure have guided me into from day 1. The “9 years later” version of me would “not do it the same way”, the “new grad” version of me had more energy and ambition and may have done it regardless of the higher debt. But I personally wouldn’t advise anyone applying to $500k+ in student loans programs to consider dentistry. The world has changed and the labor market today has more opportunities of making a good living with good income - without big non-bankruptable debt/student loans.


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[yappy]

I read somewhere/heard from actual residents that somewhere between 40-50% of ortho and Endo program residents got in through connections, and much less to do with their academic performance. I personally know an Endo resident who was close to the bottom of his class and got into residency through a connection.

Also, lot of dental school and residency faculties help their kids get into residency programs at the schools they teach - and those kids will always have better odds of getting into those programs than many stronger applicants that no one from the school heard of. So many seats in ortho and Endo programs are called “legacy seats” - and even alumni who donated a lot of money to the school or foreign countries who send a lot of their foreign dentists to some private schools qualify for those seats. So ortho is getting more competitive for those reasons more than just academic stats, because the legacy seats candidates have strong financial backing (or the cost is less of a factor than getting in through someone they know) - which encourages the ortho residency programs to keep raising the tuition every year because half the class/legacy candidates will pay at all cost, and the rest are plenty of highly competitive candidates fighting for those seats. Even if more ortho schools open, they too will charge high tuitions like the rest and fill their classes the same way. Yet, ortho in the real world is still hard work and no guarantees that any orthodontist will be financially making bank (unless their parents were already well established orthodontists - the legacy route).



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This has been my observation too. Those benefiting, and facilitating, nepotism should be ashamed of themselves. Nepotism is a wet blanket. Meritocracy will elevate the profession.
It has always been confusing to me that having family in dentistry is largely considered a positive thing. In most other fields "I want to do X because my dad/mom does it" is considered a negative.

 

[charlestweed]

Yet, ortho in the real world is still hard work and no guarantees that any orthodontist will be financially making bank (unless their parents were already well established orthodontists - the legacy route).

An ortho certificate is just a piece of paper like any other college degrees out there. It doesn't guarantee anything. Every field (including highly paid specialties like OS, endo, dermatology, GI, orthopedic surgery etc) requires hard work. Jobs don't come to you. You have to actually make a lot of efforts to find them. The GPs don't just send the patients to you when they see your office sign; you have to come to their offices and beg. If you say no to working on the weekends, no to treating medicaid and HMO patients, no to treating low income patients, no to doing in-house ortho at a GP office, no to working for a corp office that has a bossy office manager, no to a job that pays you the same as a GP etc......then your job option will be very limited....then good luck with paying back the $1million loan. Just because you spend 10+ years in school doesn't mean you are entitled to a job.

 

[gryffindor]

At first I thought this person was trolling Dave Ramsey but someone on another page said they know this doctor. He's lucky to have a fiance shouldering the startup burden and be invested in its success (well I hope she is). IMO he should only come to his office twice a week and pick up another day of work somewhere until he reaches capacity those 2 days. I hope his practice is in a location with a true need for ortho and not in a saturated market.

One of my college student patients said to me the other day that she looked into becoming an orthodontist because "it pays well." She asked me how I liked it and I said "Yes it's great but I also went to school a long time ago and don't owe anyone half a million." She's decided to try and become a nurse anesthetist instead. Medicaid is paying for her new smile and she works at the front of the local Apple store. There are so many ironies in this story. This field is not as simple as our predecessors made it look and I hope this young doctor finds financial success quickly.

 

[Cold Front]

There are at least a dozen (if not 2 dozen) dental schools that charge somewhere between $100-150k a year in cost of attendance (tuition + fees + living budget). Almost all of these schools have a 3 years ortho programs that also charge $100-150k a year as well. Couple of the grads from each of those dental schools apply and get admitted into ortho programs at the same institution each year, so they end up paying a total of 7 years at $100-150k a year... that’s $700-900k to be trained as an orthodontist before DAILY compounding interest while in school.

So my guess is - somewhere between 10-20 orthodontists from those paths/institutions graduate with $1M+ each year. In a decade, and with tuition rising every year, we will have hundreds of young practicing orthodontists with a 7 figure debt because of those top expensive schools.

I have a friend from dental school who graduated from an ortho program 7 years ago - and he walked out with $600-700k in student loans (including dental school)... if he graduated today through the same path (Boston U for dental + Ortho at Colorado), that debt would pass $1M, assuming the tuition went up 3-4% (which it actually did) each year over 7 years - plus compounding interest. Bottom line, people will still apply.



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[Anondds87]

I think a lot of people still apply because they are actually unaware of the reality of the numbers.

Most dentists I talk to are surprised to find out what associate orthos make. Its considerably less than what they expect given braces cost so much.

A lot of them apply to ortho school not knowing this. And then if they get accepted it's tough to turn down because it's so competitive and all the older orthos made millions. So theres a case of "well everyone wants to do it it must be a good gig".

I think if you could tell every applicant the reality the numbers of applications would fall off a cliff. Whereas now everyone still thinks a million dollars is a huge debt but will be worth it eventually. This opinion isnt based on fact, its largely based on the group mentality ortho is worth it no matter the cost. It isnt

 

[Cold Front]

A lot of them apply to ortho school not knowing this. And then if they get accepted it's tough to turn down because it's so competitive and all the older orthos made millions.

There might be a gender factor/twist to all these high debt. About 60% of all student loans in this country are carried by females. For the first time, we now have more females in dental school than their male counterparts. So we will have more female dentists in debt than male dentists in the future. The average female dentist works less hours due to family obligations - which means they will on average earn less than male dentists while having more debt. This will have all kinds of ramifications on the profession in the long run - more and more dentists will be in huge debt and working less. I’m not blaming female dentists at all, but it’s a trend and it will definitely be an economic factor for the profession in the future.



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[jda02624]

I don't wish failure on a colleague like this, but I can't understand taking such a risk considering the current situation in ortho. It may work out for him in the long run, but it will be quite a burden hanging over this guy's head for a long time. That can put a lot of stress on a person, on a marriage, etc. It's a lot of delayed gratification to begin with, going to college, then dental school, and ultimately ortho residency, studying hard the whole time. Now you get out +$1 MILLION in the hole. Do you buy a practice (like this guy) and go even deeper? Wait to buy a home? Wait to start a family? Is the wife going to feel it's worth it in 5 years when you are still eyeball deep in debt???
Like 2TH MVR has said elsewhere, there are no guarantees in life or health. All this can have an effect on one's level of stress, health, relationships, and life in general. It's way beyond the risk level I would be comfortable with. I hope he can make it out of this, but I certainly would want others to see his example and proceed with caution and a lot more common sense than he has.

 

[Cold Front]

It may work out for him in the long run, but it will be quite a burden hanging over this guy's head for a long time. That can put a lot of stress on a person, on a marriage, etc. It's a lot of delayed gratification to begin with, going to college, then dental school, and ultimately ortho residency, studying hard the whole time.

Well, here is what he actually said to Dave Ramsey.

“I graduated this year with little over $1M debt and I just opened up a new office with my fiancée (no mention of her being a dentist, sounded like she is not) - and we plan to get married in April”. First of all, NO DELAYED GRATIFICATION there. He took additional loans to open a new practice (that has to be over $200-300k+) few months out of residency, plus he is making plans to get married (and probably move into another place/home) few months after that. So that’s additional cost for a wedding + and move to another/new pad.

“My fiancée works at the new office and she doesn’t get paid from it. I make $250k a year and $200k of that comes working for another orthodontist. My monthly interest payment is $5,800 a month - and I would like to pay $10k a month towards the student loans, and eventually would like to pay $20, $30, or a $40k a month towards the loans”. So he is lucky to have a fiancée who is cool with making no income and getting out of bed every morning to work at his new office. Not sure how long that can last, specially for a newly weds. And to make $20, $30, or $40k post tax payments towards student loans means he would have put aside $30, $40, $50k (pre tax) from his monthly income. To me, that’s a long shot in the short term (first 5-10 years). It takes a lot of networking, referrals and a lot of luck to get that goal executed.




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[mmc12]

I’ve heard of orthodontists who can only find part time work as orthodontists and have to associate as GPs most of the week. How widespread is this?

 

[2TH MVR]

This is starting to sound like the pharmacy board lol.

 

[Cold Front]

This is starting to sound like the pharmacy board lol.

Are you enjoying reading about the student loans crisis? lol

Does your corporate employer raise their ortho fees every year? How much would they pay a new ortho grad (with a 7 figure student loan)?


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[4thgen]

With high loans and pressures from smile direct club (and other companies/GP's), where do you see orthodontics going in the future? Would you advise dental students to not go to Ortho residency even if the debt wasn't high?

 

[charlestweed]

I have not raised the ortho fees since I started my very first office 13 years ago….gotta keep the same low fees to attract more new patients. The corp office that I work for has not raised my daily pay since 2007….my bonuses are shrinking….I can’t really ask them for a raise since I don’t produce for them as much as I used to in the past. Despite all these, my overall net take home income has increased every year. It’s not because my own offices have gotten more new patients every year. The combined production for all 4 offices have been pretty much the same for the last 6-7 years….we have around 350 starts every year. I net more (and work less) now because:

1. I have reduced the overhead significantly. I (actually, it was my wife who helped negotiate) negotiated with the landlord to lower the rent on an office, that I purchased from a retired ortho in 2009, from $2700/month to $2300/month. And 1.5 years ago, I moved my very first office, that I started from scratch, to another location and the new landlord charges me $200 less every month. I also pay a lot less in ortho supplies. I used to pay $3 for a bracket. Now, I only pay 50 cents each. I used to send all the appliances to an outside lab. Now, I make 90% of them in-house. I have not purchased anything new. I still use the same equipment and chairs that I purchased 13 years ago.

2. I don’t have to set aside $20-25k every month like I used to in the past to pay back student loans, business loans, home mortgage, rental properties’ mortgages etc. All my debts (except for the home mortgage) were already paid off.

3. I didn’t quit nor cut down my work days at the corp when my own offices got busier. To handle higher patient load at my own offices, I just hired more P/T chairside assistants to help me… so I didn’t need to add more days at my offices and cut down days at the corp.

4. Passive income from my rental properties. The company that helps manage my properties is very good at raising rents on my tenants every few years.

I hope this new grad orthodontist’s office will get a lot of patients soon. During the first 4 years, my associate income was just slightly higher than his but I had to work 5+ days/week. Back the the day, associate orthos in CA only got paid $800-950/day. I started making a lot more when I set up my own office in 2006….and then purchased another office in 2009....and added 2 more offices by renting spaces from GPs. I am also very lucky that I married a right person.

 

[beannaithe]

It's crazy to think that ortho went to school for 11 years and is $1mil in debt to work 6 days a week. I also think he might be overly optimistic to think that he'll be able to plug $40k away at the loans eventually. I think 6 days a week is unrealistic to manage for years. And life eventually gets expensive with wanting to be able to buy a house and a car and have kids, etc.

I'm a GP who does the occasional Invisalign case, so I doubt my opinion holds much weight. But I see more and more patients doing DIY ortho. I also see more and more patients see the ortho who does the cheapest braces in town. $3500 for any patient: regular braces/Invisalign. He does a great job, but dang, I can't imagine there's much profit left for Invisalign. It's probably not bad for conventional braces.

 

[Anondds87]

With all this depressing talk of ortho is there anywhere in the world where it's still good?

Does anyone know what it's like in dubai?

 

[Cold Front]

I have not raised the ortho fees since I started my very first office 13 years ago….gotta keep the same low fees to attract more new patients. The corp office that I work for has not raised my daily pay since 2007….my bonuses are shrinking….

So it sounds like your ortho fees and almost every ortho provider fees will not increase in the future, or possibly go down due to saturation/competition and DYI ortho. So what’s the point getting into ortho with $700k-1.2M debt today (probably $900k-$1.5M in 10 years) if fees and student loans are going at different directions at a 5% rate every year?




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[charlestweed]

So it sounds like your ortho fees and almost every ortho provider fees will not increase in the future, or possibly go down due to saturation/competition and DYI ortho. So what’s the point getting into ortho with $700k-1.2M debt today (probably $900k-$1.5M in 10 years) if fees and student loans are going at different directions at a 5% rate every year?




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I don't know if other orthodontists raise their fees or not. I choose not to because of all the reasons I listed above....the operating cost of running my offices is lower (brackets and wires are getting cheaper and all the debts were paid off) than when I first started. I want the new patients to be happy with our fees and services. In order to maintain the same constant income flow that I currentlly enjoy, I need new patients to come in to replace the ones who are done with their tx.

Orthodontists are not the only ones who suffer from rising student loan problem. Doctors, general dentists, pharmacists, and all people who attend colleges face this problem as well. At least orthodontists can pay back their loans by opening their own offices while having multiple part time jobs somewhere else. A lot of college grads with social sciences degrees can't find jobs and have to move back home to live with their parents. Working as an orthodontist 6 days/week is 100x easier than working 3-4 days/week as a general dentist. Orthodontists can work for a long time and they will continue to earn 6-figure incomes while most of the general dentists at their age have to quit due to hand and back problems. If God allows me to live past my retirement age, I will continue do ortho. It'd be boring for me to stay home doing nothing 7 days/week, 365 days/year. It's hard to quit this fun job completely.

 

[bracketbuster68]

Ortho is dying. The golden days are over. They struggle to make any money. Anyone reading this, don't go into ortho - not because it's a dying field, but because I want to get in next cycle.

 

[Cold Front]

Working as an orthodontist 6 days/week is 100x easier than working 3-4 days/week as a general dentist. Orthodontists can work for a long time and they will continue to earn 6-figure incomes while most of the general dentists at their age have to quit due to hand and back problems. If God allows me to live past my retirement age, I will continue do ortho. It'd be boring for me to stay home doing nothing 7 days/week, 365 days/year. It's hard to quit this fun job completely.

That’s not true. A busy and established General dentist office would be a better gig to work past retirement age. General dentists in my state can have upto 4 dental hygienists and (soon) dental therapists. So that would be a completely hands free practice and you would only have to be there if you have “new patients” or “emergencies” (under the current law ) - but that too will change in the future.

You still haven’t answered the question - why would anyone go into ortho today and be in position to be in big debt - when you can use that same money to open 2-3 general dentist offices, and still use that money in the practices to depreciate against your income taxes? Any high school student with ortho future goals today is looking $1M+ debt in 10-15 years. What is the financial rationale to support such decision? I’m not talking about your low overhead and permanent low fixed fees - I’m talking about the average future orthodontist. Think the year 2030 average ortho grad with about $1M+ in student loans (and didn’t have rich parents or rare scholarships).


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[Cold Front]

Ortho is dying. The golden days are over. They struggle to make any money. Anyone reading this, don't go into ortho - not because it's a dying field, but because I want to get in next cycle.

Unfortunately, the conveyor belt to ortho residency is still in high gear and very expensive.


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[Anondds87]

I think that's a totally valid question. I honestly dont think I'd recommend ortho to a high school student, in fact I'd strongly tell them to stay away.

If you can start ortho soon and do it cheaply I'd still recommend it. But if you're leaving high school now absolutely not. And I think it should be ok to tell young people this - in fact it's doing them a huge service.

 

[Big Time Hoosier]

Unfortunately, the conveyor belt to ortho residency is still in high gear and very expensive.


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I can’t believe that some programs take 15+ residents a year. That alone should give ortho aspirants pause.

Big Hoss

 

[charlestweed]

That’s not true. A busy and established General dentist office would be a better gig to work past retirement age. General dentists in my state can have upto 4 dental hygienists and (soon) dental therapists. So that would be a completely hands free practice and you would only have to be there if you have “new patients” or “emergencies” (under the current law ) - but that too will change in the future.

If it’s so simple to make money, then why do most old dentists sell their practices and retire? Most old dentists sell their practices because they no longer produce the same as when they were younger. You can’t really be “hand-free” if you want your office to continue to attract more new patients. Patients come to your office because of your reputation and your good work. In order to maintain the success of your business, you have to be actively involved in running your practice and be good at performing difficult procedures. Since you have the experience in hiring associates, I pretty am sure you know that most associate dentists don’t care about your practice the way that you do. The associate dentists only want to do minimum work, refer difficult high risk cases to specialists, go home early, and get paid ontime. When you start letting your office managers, associate dentists, and hygienists run your office, your office will soon be just like most corp offices…..poor customer services, long wait time, lots of re-dos, and lots of patient complaints etc.

Many successful dentists (ie Tanman) still have to sit down to do most of the work by themselves because they don’t trust their associates….it’s their practice....it's their reputation that they are trying to protect.

You still haven’t answered the question - why would anyone go into ortho today and be in position to be in big debt - when you can use that same money to open 2-3 general dentist offices, and still use that money in the practices to depreciate against your income taxes? Any high school student with ortho future goals today is looking $1M+ debt in 10-15 years. What is the financial rationale to support such decision? I’m not talking about your low overhead and permanent low fixed fees - I’m talking about the average future orthodontist. Think the year 2030 average ortho grad with about $1M+ in student loans (and didn’t have rich parents or rare scholarships).

If it’s too easy for general dentists to open 2-3 offices to make a ton of money, then why do very few of them have multiple successful offices? Many of them cannot even run one office successfully. If it’s too easy to make $$$ as a general dentists, then why do many of them want to go back to school to specialize?

Like I said before, one should not have to borrow any loan for the undergrad education. If he/she is too poor, the government will give him/her grant money or he/she can always get a P/T job….if he/she doesn’t want to get a P/T job, then I don’t think he/she is a responsible person…and he/she will likely fail in the future. One doesn’t need to get his undergrad education at Stanford and Harvard in order to get accepted to a good cheap dental school. Most cheap local state universities are good enough.

 

[Cold Front]

Since you have the experience in hiring associates, I pretty am sure you know that most associate dentists don’t care about your practice the way that you do. The associate dentists only want to do minimum work, refer difficult high risk cases to specialists, go home early, and get paid ontime. When you start letting your office managers, associate dentists, and hygienists run your office, your office will soon be just like most corp offices…..poor customer services, long wait time, lots of re-dos, and lots of patient complaints etc.

If it’s too easy for general dentists to open 2-3 offices to make a ton of money, then why do very few of them have multiple successful offices? Many of them cannot even run one office successfully. If it’s too easy to make $$$ as a general dentists, then why do many of them want to go back to school to specialize?

Like I said before, one should not have to borrow any loan for the undergrad education. If he/she is too poor, the government will give him/her grant money or he/she can always get a P/T job….if he/she doesn’t want to get a P/T job, then I don’t think he/she is a responsible person…and he/she will likely fail in the future. One doesn’t need to get his undergrad education at Stanford and Harvard in order to get accepted to a good cheap dental school. Most cheap local state universities are good enough.

Associate dentists who are paid by a % of what they produce do not and cannot afford to do minimum work. It is true they don’t work as hard as the owner (I wouldn’t if I was the associate) - but the owner should have that expectation when hiring an associate. Like anything else, if you provide the right perks/incentives, environment, staff and schedule to the associate, something better than other associate jobs out there, they will not leave under normal circumstances. Ofcourse an associate can still leave if their spouse, family or other non-financial personal obligations pulls them somewhere else.

By the way, I never mentioned “associates” in my previous post for a general dentist to retire comfortably. It was hygienists (up to 4) and dental therapist(s) who work in a well established and busy practice that can make a general dentist retire comfortably. The dentist can assume the general manager position and step away from the handpiece/treatments in this scenario - so the practice leadership and style will not be like a corporate office. This is my goal down the line, maybe in 15-20 years.

Also, in my experience, dentists who go back to school and specialize are either not cut out for general dentistry hustle, not good at managing staff and run an office, or simply want to make a higher baseline income. If you think majority of specialists didn’t get into their fields for monetary reasons - that would be a naive observation. These days, going back to school and specialize comes with 200-300k minimum before the compounding interest in additional debt/student loans, plus the $400-500k income potential loss as a general dentist - and most importantly TIME!. Any general dentist going back to school to specialize must think long and hard about it. Those numbers will only get worse in the future with tuition and other cost going up every year.

To your final point, I don’t think the average undergrad comes with good grants anymore, so the “average” dental school applicant will carry some level of student loans before they get into dental school. Besides, what does the average 18 yr old know about debt? They are more worried about enjoying their youth and having fun in college. You and I and few others on this thread are the exception - we grew up differently and were more financial conscience than the average undergrad student.



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[2TH MVR]

Some thoughts from a practicing orthodontist who practiced during the Golden years (pre-2007), owned and started 2-3 ortho practices, purchased investment real estate, sold his practices and now works 4-5 days at a dental Corp.

1. YES. The Golden years of ortho are past us. Will they be back? Not sure. But doubtful. At one time ortho had the monopoly on straightening teeth. This does not exist now. Our patient pool is so much smaller now with so many players (Align, SDC, GPs and others doing ortho).

2. Is ortho worth over 700K? I'm not sure it is worth over 500K. It was worth it for me. I graduated with less than 100K. Maybe I was lucky. But I paid nothing for undergrad (scholarships). Went to a cheap undergrad college. Went to a cheap midwest dental school. Recieved a stipend in ortho residency. I worked a PT job during undergrad and my wife helped with bills during my ortho residency. What I see is lesser qualified students/dentists trying to BUY themselves into a profession.

3. Most orthodontists could not practice like @charlestweed . His unique perspective and work ethic allows him to prosper in a very difficult saturated ortho market. I cannot imagine young graduating orthodontists are going to set up a low budget low fee ortho practice. It's not the reason most of us went to ortho residency in the 1st place.

4. New orthodontists are going to have to diversify their employment. This is not different from the Golden years. Most orthos back then had multiple offices. Many orthos partnered up with Pedos. Many worked out of GP offices. The positive here is that their are MANY employment opportunities for orthodontists because EVERYONE wants ortho services offered in their offices. It generates revenue. I see it every where. EVERY dental office starts with their name and has BRACES at the end. Risas Dental and Braces. ColdPlay Dental and Braces. Etc. etc.

5. Orthos are going to have to travel. That's reality. I mentioned before that I started a small practice in a small town where my mother wintered. 2 and a half hours from Phx. GP begged me to use his office and see his ortho pts. There was NO orthodontist in this small town. I practiced in his office for 5 yrs, but then my main practice was getting busier .... so I discontinued that small town practice. To this day ... there is still no orthodontist at that small town. Could it support a full time ortho? No. But definitely a PT ortho. Rural areas still offer the best options for new orthos.

6. Working in Corp ortho is not bad for someone like myself (age 57). For a young ortho with large debt ... Corp ortho is one of many employment options. It's a **** show for sure, but for some sick reason .... I like it. lol.

7. As for the future of ortho. I see it becoming less and less popular as a post residency. A future orthodontist will be like prosthodontists. We'll be treating only the most difficult cases that nobody wants or can treat.