ASK a DENTIST

[desert rat]

$300,000 is alot of money owed. It all depends on what is the payback amounts.

I don't feel the majority of dentists are ready to open their own practice right out of school. There is alot that you need to learn before that. You also need time to figure out where you want your practice. Don't rush things.

California has alot more competition than AZ. In the big cities of AZ there is more compitition than in the rural areas. Also look at cost of living and schools, and housing. Look at tax rates, state, county, city, and sales tax. Look at lease costs in different states and cities.

There is alot that goes into figuring this all out.

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[blissdental]

Desert rat, competition is higher in big cities but what if the population is too low in smaller cities? I don't mind working in a rural area, but I always wonder on how rural I should go. In some rural ares are there actually enough patients there to run a dental office? Can I ask how small the population was in the city that you practiced? Did you have to drive miles and miles, and hours and hours away from you office until you came across another dental office?

 

[DrJeff]

Desert rat, competition is higher in big cities but what if the population is too low in smaller cities? I don't mind working in a rural area, but I always wonder on how rural I should go. In some rural ares are there actually enough patients there to run a dental office? Can I ask how small the population was in the city that you practiced? Did you have to drive miles and miles, and hours and hours away from you office until you came across another dental office?

As someone who has practiced (and lived) in both suburbia and rural areas, the "mentality" of a small town patient is often VERY different that that of a more urban/suburban patient. A rural patient who is often very used to having a 15 to 60 minute drive for things like a trip to the mall or even a trip to a grocery store really doesn't think twice about that length of drive for their dental care. That being said, you may very well be the "only dentist" within 30 miles, and as a result you'll often have the majority of the 50% or so of the general population that seeks dental care on a regular basis as your patients.

Whereas is a urban/suburban area, someone may not got more than a mile to get to your office, if for no other reason than they'll likely pass another dentist's office or two along the trip from their house.

Another key difference that very often happens with a rural office verses an urban/suburban office is the difference of what you'll often spend in advertising expenses. Word of mouth is great(and free), and is often the advertising method you'll be doing in a rural setting in addition to your name being listed in the yellow pages. In an urban/suburban setting where "competition" for patients is often greater, you'll likely be spending some $$ (and sometime ALOT of $$) on marketing in various forms, and while it will often increase your production, it also increases your overhead.

In my case, the majority of my patients come from the town where my office is located in and the surrounding 5 towns. Those 6 towns make up an area that is close to 20 miles sqare and have a population of around 35,000 - 37,000. There are 11 general dentists practicing within that area. Plenty of work for all of us. No problems when I need to refer a patient whose already driven 15 miles to see me to a specialist whose another 30 miles down the road. That's just small town way of life

 

[pmantz]

Wow, I know a former Navy dentist, did the 4 year HPSP, and is now making great money in private practice and loved his experience in the Navy. I think it is different for everyone and can't truly be generalized. He never saw combat once and didn't even have to go out on a ship...

There probably wasn't a war.

 

[Frederico Albin]

$300,000 is alot of money owed. It all depends on what is the payback amounts.

What do you suggest for a dental school graduate who has less debt than that? Lets say, $60k.

What would you suggest doing first? Paying off that $60K or buying a practice?

 

[desert rat]

What do you suggest for a dental school graduate who has less debt than that? Lets say, $60k.

What would you suggest doing first? Paying off that $60K or buying a practice?
I would suggest you get out and get a job working for someone and learn what it is to be a dentist. There is so much to learn after you graduate. The problem is that when you graduate you think you know dentistry, but your first 6 months you will find you don't.

Also you need time to figure out the best location for a practice and where to buy everything you need. You do not want to rush into this.

 

[elephants]

How many hours a week would you suggest working when first getting out of a GPR? With a family, that is.

 

[DrJeff]

How many hours a week would you suggest working when first getting out of a GPR? With a family, that is.

When I first got out of my GPR, I was working 5 1/2 days a week (M-F 9-5 and Saturday 8-12:30). I realized after a few months of that that a) I was fine with the $$ of 4 1/2 days a week and b) my mental sanity was MUCH better on 4 1/2 days a week.

The family factor is one where you'll need to find the balance yourself that will keep you happy both financially and as a parent. For many that will be in the 4 to 5 days a week range.

 

[pmantz]

When I first got out of my GPR, I was working 5 1/2 days a week (M-F 9-5 and Saturday 8-12:30). I realized after a few months of that that a) I was fine with the $$ of 4 1/2 days a week and b) my mental sanity was MUCH better on 4 1/2 days a week.

The family factor is one where you'll need to find the balance yourself that will keep you happy both financially and as a parent. For many that will be in the 4 to 5 days a week range.

I can imagine myself doing the same thing but realizing I can't do it after about 5 days.

 

[getdental]

How many hours a week would you suggest working when first getting out of a GPR? With a family, that is.

It depends on how you can balance family with work. You may know you may not. I would suggest having a family budget and meeting the budget by the hours you work. If you can work more it's gravy. If you can't at least you are meeting your financial obligations.

Do you plan to own or work as an associate?

 

[Calidental]

Maybe I'm going against the grain with all the specialty hate, but it doesn't seem ridiculous to me that someone who has spent 3 years of their life training in one specialty, and completely limits their practice to said specialty would, on average, be more highly trained to perform procedures within that specialty.



I find it funny that most of the people who would speak out against say, the ADHP program, would assert basically the same thing as the hygienists when they're talking about advanced procedures.

Seems you're thinking logical to me Armorshell. If I was having plastic sx, id want the plastic surgeon who did it week in week out, not the general surgeon with an interest in it, who does it less frequently, even if GS did it more my answers still no. Residency doesnt just teach you what to do, but also how to deal with complications in a structured, supervised 3 year program.
We argue ADHPs dont have an advanced degree like us DDS so they should stay put with less complex procedures but when a specialist says this to the very same anti ADHP generalist apparently its heresy.

 

[desert rat]

When I first started out in dentistry I was in the Army. I worked 4 days a week in the Army and two days in private practice each week. I did that for one year. after that it was 4 days a week for one year in the Army.

When i stared in private practice full time I worked 5 days a week for 5 years. I then started working 4 days a week taking Wed. off. Now I work 4 day work weeks and take plenty of days off each month for fun. As you get older you start valuing time and taking more hours off.

When your young work long and hard. Make your money while you have the energy to do so. Later in life you can cut back on the hours. Afterall, most occupations would require 40 hours a week.

The hardest working dentists I have seen are oral surgeons that work 40 hour weeks and emergency hospital calls all weekend. They make more money but work more.

When you first start off in general dentistry get proficient at doing all aspects of dentistry. Try not to refer out to specialists unless you have to. You will appreciate the extra income and your patients will be happier. I find most patients do not like to be refered out. They prefer you to be able to handel their care. However, if you can't do a procedure send it out. Some procedures you really need to refer out because they are money losers for a general dentist. Such things are; impacted molar removal, second molar endo on severely curved roots or gagging patients, kids that fight you, any patieint that has a history of suing dentists. Thank God for specialists that will let us send these patients to them.

Great continuing education for a recent graduate general dentist providing you don't want to be the cosmetic LVI dentist:

1. Implant training (Mish insititute), Nobelpharma, Bicon, Las Vegas Implant institute, or others.
2. Harry Green's Tip-edge orthodontics course.
3. Mike Melkers occlusion and NTI training in Washington.
4. Glassman's sleep/snoring training.
5. DOCS oral sedation or an IV sedation course
6. EDS Safesider endo course
There are many more, but these are a great beginning.

Join the AGD and start working on your FAGD or MAGD right after you graduate. It is a nice group to belong to and it will make you a better dentist.

 

[hidocs]

hi desert rat.could u tell how much money on average a general dentist make through a job right cmg out of school??

 

[Regmata]

hi desert rat.could u tell how much money on average a general dentist make through a job right cmg out of school??

lol

 

[elephants]

It depends on how you can balance family with work. You may know you may not. I would suggest having a family budget and meeting the budget by the hours you work. If you can work more it's gravy. If you can't at least you are meeting your financial obligations.

Do you plan to own or work as an associate?

I'm not really sure yet. I was thinking I'd probably work as an associate for a few years, and then try to buy my own practice once I'd earned enough to do so.

Also, at Desert Rat (or anyone else who knows): how do you know which patients have a history of suing dentists?

 

[pietrodds]

If you asked them outright.... they'll probably sue you for discrimination!

When you start seeing new patients in private practice, red flags will go off immediately with just a short conversation. Just ask them about their previous dental experiences and you'll probably have to cut them off at about 10 minutes after they're probably onto talking about how bad their eigth dentist was.... or the just come in with a bag full of dentures.... or they're standing up when you first come in the room eyeing you down.... or they start rattling off dental terms like they went to dental school... or you get a call before they come in from another dentist just as a 'heads up'...

95% of patients are great, you just have to be leary of the 5% out there. The unfortunate thing about being a young dentist is that you're eager to please and eager to treat. A wise dentist said once to never treat a stranger.

 

[desert rat]

pietrodds you answered it well. It is amazing how much they tell you. Also in a small town you know everything about everyone.

how much will you make when you graduate? read through this thread. I can't tell you that. Everyone is different.

 

[b333b]

do you really work 4days/wk in the army?? i.e. if you're not deployed, you just see patients 4days/wk and u dont have to come in to work on the other days?
and regarding patients: those women that flashed you or otherwise flirted, were they meth addicts or ugly or old, or normal women did it too? and what happens if some woman claims that you sexually harassed her(say fondled her breasts under anesthesia or something equally bad) for no apparent reason? will you be guilty untill proven innocent?

 

[m-dmd]

do you really work 4days/wk in the army?? i.e. if you're not deployed, you just see patients 4days/wk and u dont have to come in to work on the other days?
and regarding patients: those women that flashed you or otherwise flirted, were they meth addicts or ugly or old, or normal women did it too? and what happens if some woman claims that you sexually harassed her(say fondled her breasts under anesthesia or something equally bad) for no apparent reason? will you be guilty untill proven innocent?

No you do not work 4 days a week anymore. Some bases still have flex time, but most have done away with it from what I understand. I work 5 days a week in the Army (until tomorrow which is my last day).

 

[Gunner McGee]

Have you wanted to talk with a practicing general dentist without all the BS that a dental professor or specialist gives you? Fee free to ask me any questions and I will tell you how it really is.

Why does music always suck in dental offices? Why not play something decent?

 

[OceanDMD]

Why does music always suck in dental offices? Why not play something decent?

We play Jimmy Buffett and other "island like" music mostly. Problem is, unless the music is just dull meaningless boring stuff, you always have the chance of offending someone. We leave the "why dont we get drunk and screw" song off the playlist.

 

[desert rat]

We play whatever our staff feel like at the moment. Most of the time it is top hits. Every once in awhile I like to put it on the 70s channell. Patients that are old like the 70s, but most young people like the top hits. We use XM radio in our office.

 

[blankguy]

We play Jimmy Buffett and other "island like" music mostly. Problem is, unless the music is just dull meaningless boring stuff, you always have the chance of offending someone. We leave the "why dont we get drunk and screw" song off the playlist.

How about classical music? That definitely won't offend anybody.

 

[blankguy]

I just walked into a practice where they show X-rays on flat panel screen so that expensive (so I'm told) X-ray sheets are not necessary. Do you have any such arrangements? Also now that I mention are your practices have computerized patient records instead of folders?

 

[desert rat]

Our office is computorized. I doubt there are many offices not computorized anymore.

The XRAY you refer to is digital XRAY. most practices are starting to move into that.

 

[HawkeyeDDS]

When will bashing GP's for bashing specialists for bashing GP's ... for bashing specialists, for bashing GP's end ?!

I love specialists. I love the fact that I can refer the stuff I don't want to do. I love taking out impacted molars on a healthy 19-25 year old, but when I see a distoangular it goes to the surgeons. When I see an upper molar, or a premolar with a dilacerated root or calcified canal, it goes straight to the endodontist. Long story short, I send them all the stuff I don't want to do. It's not a matter of "if" I could do it, it's a matter of "if" I could do it in a resonable amount of time to be profitable. To many dentists in our profession need to get over the "little man" syndrome, after all we did only get into dental school because we didn't get into Med School.

 

[PingPong700]

Hi,
I'm not a Dentistry student so I hope its ok that I post here. I went to see the Orthodontist today about extracting my Wisdom teeth. From the X-Rays I took today, the two on my bottom jaw for sure look like they need to be extracted as they are angling in on the other teeth at almost 45 degree angles.

But the top two wisdom teeth do not look too bad as they are only angled a little and have not come out of the gums or anything.

What are the chances my top wisdom teeth will become functional and not cause any harm as I get older? Should I just remove all four wisdom teeth at once, so I don't have to worry about complications later? I can post my X-Ray if you want. Thanks!

 

[reapply2007]

Why not start your own thread? Better yet, ask your dentist.

 

[aggie-master]

Hi,
I'm not a Dentistry student so I hope its ok that I post here. I went to see the Orthodontist today about extracting my Wisdom teeth. From the X-Rays I took today, the two on my bottom jaw for sure look like they need to be extracted as they are angling in on the other teeth at almost 45 degree angles.

But the top two wisdom teeth do not look too bad as they are only angled a little and have not come out of the gums or anything.

What are the chances my top wisdom teeth will become functional and not cause any harm as I get older? Should I just remove all four wisdom teeth at once, so I don't have to worry about complications later? I can post my X-Ray if you want. Thanks!

I think it is against forum rules to ask for medical advice here. Also, no dentist is going to give you a professional opinion without examining you personally due to liability issues.

If you don't trust your dentist go see another one to get a second opinion.

 

[OceanDMD]

Hi,
I'm not a Dentistry student so I hope its ok that I post here. I went to see the Orthodontist today about extracting my Wisdom teeth. From the X-Rays I took today, the two on my bottom jaw for sure look like they need to be extracted as they are angling in on the other teeth at almost 45 degree angles.

But the top two wisdom teeth do not look too bad as they are only angled a little and have not come out of the gums or anything.

What are the chances my top wisdom teeth will become functional and not cause any harm as I get older? Should I just remove all four wisdom teeth at once, so I don't have to worry about complications later? I can post my X-Ray if you want. Thanks!

You need to go straight to your local oral endomaxilloprosthologist. They are experts at telling you if a wisdom tooth will become functional. Go ask you dentist or orthodontist for a referral to the local endomaxilloprosthologist.

 

[lanvin12]

Do you have any advice for a high school senior, starting as a freshman next fall?

 

[Jaylee777]

Thank you to all the contributing Dentists on this thread...great advice and insight.

Dr. Desert Rat- You mentioned that after the Army you worked for a year before buying the land and building the strip mall...did you work at the existing private practice that you were planning on buying? Also, did you build the new office in close proximity to the old practice? How was your experience in taking over patients that had been with the previous dentist...were they generally receptive to someone new?

This one is for any dentist viewing the thread- What are some things you think that a general dentist needs to do or needs to look for when trying to build a successful office in a large city with many other competitors?

thanks in advance

 

[PingPong700]

You need to go straight to your local oral endomaxilloprosthologist. They are experts at telling you if a wisdom tooth will become functional. Go ask you dentist or orthodontist for a referral to the local endomaxilloprosthologist.

Not funny.

Anyways what I did was against the ruels. Sorry guys.

 

[pmantz]

You need to go straight to your local oral endomaxilloprosthologist. They are experts at telling you if a wisdom tooth will become functional. Go ask you dentist or orthodontist for a referral to the local endomaxilloprosthologist.

How competitive is that specialty?

 

[bbowers1512]

To the Dentist:

My girlfriend is training to be a dental assistant. She has taken her chairside courses, and her test. She is now moving onto "Part 2" of her ?? CDA ?? Certification...The Radiology section. She has just taken her test, and she failed, and I was wondering if there are any study guides that you would know of that might help her with her Radiology Exam.

Aparently, shes not allowed to push the X-Ray button on a patient unless she has this certification...maybe that might explain what it is that I am talking about... I am really clueless to this stuff, but any help would be greatly appreciated, as I am trying to help her the best that I can...

I also apologize in advance if this is not something you know of, I am looking for any help I can get...

 

[DrJeff]

How competitive is that specialty?

Ultra, ultra, but the starting salary on average is $3,750,000 for a 1.5hour work week and 46 weeks of vacation a year

 

[Frederico Albin]

Ultra, ultra, but the starting salary on average is $3,750,000 for a 1.5hour work week and 46 weeks of vacation a year

That's after you spend 60 years in residency

 

[Hysteria24]

That's after you spend 60 years in residency

Ouch... I'd hate to see the amount of loans they amass. That $3,750,000 might not be worth it!

 

[MnBr63]

Why does music always suck in dental offices? Why not play something decent?

I think on the first part of the boards you have to sign an agreement to play at least 3 Phil Collins or Genesis songs through out the working day in a dental office.

 

[DrJeff]

I think on the first part of the boards you have to sign an agreement to play at least 3 Phil Collins or Genesis songs through out the working day in a dental office.

You forgot about the mandatory "Yanni lunchhour set" that has to be played too

Seriously though, my office tunes are via XM, and we rotate the channels between classic rock, coffee house blend, adult contemporary, or whatever else within reason the person who turns the receiver on in the morning sets the channel too.

You'd actually be suprised too at how many patients ask "what station is this?" Especially if they don't have satellite radio in their car/house.

 

[Fido00]

How do you handle call? I have heard some people mention that there is no call with dentistry and I cannot imagine how that would work. What about if you are going out of town/country, etc?

 

[DrJeff]

How do you handle call? I have heard some people mention that there is no call with dentistry and I cannot imagine how that would work. What about if you are going out of town/country, etc?

In my situation its pretty easy. Both my partner and I have our cell phone numbers on the answering machine. If our patients have a problem/question they call us directly. If one of us is on vacation, the other covers for the entire office. If we're both away (occassionally during big dental meetings) then we have one of the other local GP's cover for us while we're away and are more than happy reciprocate for them if need be.

In my practice atleast I'll get 1 or 2 calls a month tops, so call definately isn't a big deal for me. Of the limited calls I do get, maybe once or twice a year will I actually have to go into the office to do something, the vast majority I find though can usually be handled with some answers to questions and/or a call to the pharmacy.

 

[OceanDMD]

In my situation its pretty easy. Both my partner and I have our cell phone numbers on the answering machine. If our patients have a problem/question they call us directly. If one of us is on vacation, the other covers for the entire office. If we're both away (occassionally during big dental meetings) then we have one of the other local GP's cover for us while we're away and are more than happy reciprocate for them if need be.

In my practice atleast I'll get 1 or 2 calls a month tops, so call definately isn't a big deal for me. Of the limited calls I do get, maybe once or twice a year will I actually have to go into the office to do something, the vast majority I find though can usually be handled with some answers to questions and/or a call to the pharmacy.

So, are you saying your temporaries never come out, or when they do(on the weekend) you do not go in for the patient. Ive tried the "put the temp back on yourself direction", most the time the patient has no clue. When you are prepping 5-10 crowns a week, with a few being anterior, I have a call probably every other weekend. I go in when they call if its a temp out, even without pain. If the patient is paying 1k/crown, I think they expect to have something like this handled. How do you handle it doc?

 

[My3kGT]

You may have an advantage in this since you have some business training, but how much time do you spend in the "business" part of your practice vs. actual dentistry? I am not a dentist but my son is. I have sen too many doctors (both MD and DDS) who were making tons of money but hit 60 an didn't have 10 cents in the bank. So any comments to those who may be highly skilled in dentistry but clueless in business management who be interesting.

 

[DrJeff]

So, are you saying your temporaries never come out, or when they do(on the weekend) you do not go in for the patient. Ive tried the "put the temp back on yourself direction", most the time the patient has no clue. When you are prepping 5-10 crowns a week, with a few being anterior, I have a call probably every other weekend. I go in when they call if its a temp out, even without pain. If the patient is paying 1k/crown, I think they expect to have something like this handled. How do you handle it doc?

Knock on wood, although by posting this, the jinx will be on this weekend(especially since my partner is currently in Texas for a swim meet), most of my temps stay in place (granted I tend to cut a REALLY parallel prep and have been known to lock the occasional one on every now and then)

If it's an anterior temp, and my cell phone rings, I'm seeing them in the office after hours. If it's a posterior endo treated tooth and it's Sunday at 3PM, well, it's probably waiting until Monday AM for a fresh mix of temp-bond. And even at 1k/crown 99% of patients that fall into this category seem to be fine with this, and that other 1%, well that's the person who you already know is a P.I.T.A. and the second you hear "Hi Doc, this is X" on the phone, you're looking for the car keys and telling them that you'll see them at the office in 30 minutes.

 

[DrJeff]

You may have an advantage in this since you have some business training, but how much time do you spend in the "business" part of your practice vs. actual dentistry? I am not a dentist but my son is. I have sen too many doctors (both MD and DDS) who were making tons of money but hit 60 an didn't have 10 cents in the bank. So any comments to those who may be highly skilled in dentistry but clueless in business management who be interesting.

In actual physical hours in the office, I'm probably 90% "gloves on dentistry" and 10% the "business of dentistry." Mentally though I'm probably 20% "gloves on dentistry" and 80% the "business of dentistry."

Most folks in dentistry just plain and simple don't have the solid financial/business/managerial background that they really need when graduating from d-school. Also, many folks in dentistry tend to be "too proud" to realize early enough that they need to ask for help with things like the business side of dentistry to get the help/advice that they very well may need to operate both day to day and also long term on an efficient and profitable way. Finding a team of folks(both people that you employ on a daily basis and people whose firm/company you use) to give you the proper advice also isn't something that will usually not happen overnight - afterall a recent grad who is just starting out and has just 1 front office person and 1 assistant working for them has much different business needs than that of an office with 2 fully bought in partners, 4 hygienists, 4 assistants, and office manager and 2 or 3 other front office staff members.

 

[Frederico Albin]

How long did it take to get a good flow of patients in your practice? What kind of marketing methods do you guys use?

I don't know if that is asking too much, I'm just a curious cat.

 

[DrJeff]

How long did it take to get a good flow of patients in your practice? What kind of marketing methods do you guys use?

I don't know if that is asking too much, I'm just a curious cat.

Getting a good flow of patients will be quite a bit location and type of practice based. In my case, with both practices I have worked for, I joined into a very active restorative/hygiene driven "family practice" - my 1st associateship was in modern day suburbia and now the practice where I'm a partner is in a decidely rural area. In both cases when I joined after looking at the past records of the practice, they had been averaging roughly 50 new patinets a month for the previous 2 years. As the new associate both times, the senior doc(s) were basically overwhelmed with their already established patients, so unless the patients specifically request the senior doc(s) or was a relative of an existing patient of the senior doc(s) all the new patients were assigned to me.

Both time, I within 2 to 3 months I had a schedule that was basically full for a few weeks out with productive patients. Not all practices will have this type of new patient volume coming through, especially in areas where the dentist population is already quite high.

I've been very lucky in that with both practices I've been a part of, the senior doc(s) have had a GREAT reputation in the local community and advertising was little more than 1 line in the dentist section of the yellow pages, combined with a small add in the local paper that ran for a month at most saying essentially "the Dr(s) X would like to announce that Dr Jeff has joined the practice and is accepting new patients. Dr Jeff graduated UCONN Dental School in 1997 and spent 2 years in a general dentistry residency program at St. Francis Hospital. Please call 867-5309 to schedule an appointment with Dr Jeff"

I know that my situation with the limited advertising needed to quickly fill my schedule with quality patients isn't always the case, but once again the benefit of the old addage "location, location, location" worked in my favor.

In other areas with either a new startup and/or a high dentist population you very well may need to use some kind of direct mail service combined with frequent atleast print adds to get your name out. But then you really need to track just how many patients those advertising dollars are bringing in to get the most cost effective return on your investment (i.e. does your print add generate alot more calls than your direct mailing, etc)

Also, if you're starting a general practice than you'll typically develop a sizeable patient base alot quicker than if your starting up more of a "niche" practice (i.e. dental spa, cosmetics only, etc)

 

[Frederico Albin]

Thanks for the reply DrJeff. I really like reading about how different dentists start practicing after dental school. It gives me motivation.
One more question, are you practicing in Connecticut?

 

[DrJeff]

Thanks for the reply DrJeff. I really like reading about how different dentists start practicing after dental school. It gives me motivation.
One more question, are you practicing in Connecticut?

Yup, I'm a CT practicing dentist, way up in the Northeast Corner