Ask me Anything...

[LLUDDS15]

Hey Guys,

I used to frequent these boards when I was in your position looking for advice. I may not be the best person to ask about DATs and NBDEs, but I have been in private practice for almost 2 years now, just bought my own practice about 6 months ago. It's been a hectic transition, but I LOVE having my own and being my own boss. I wanted to give back and try to help out wherever possible because I was in your position not long ago. Keep up the fight and perseverance, you will be more than happy when it's all over and done. Dentistry is absolutely the most rewarding career you could ever ask for.

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[SnozzBerry]

Population of area where your practice is located ? Expected annual income ? Mix of procedures you do ? How many hygienists ? Why did you pick the practice you did ? What is your overhead ? How much did you pay for the practice as a percentage of gross production of practice/whatever system you used to value it.

 

[LLUDDS15]

Population of area where your practice is located ? Expected annual income ? Mix of procedures you do ? How many hygienists ? Why did you pick the practice you did ? What is your overhead ? How much did you pay for the practice as a percentage of gross production of practice/whatever system you used to value it.

1) Population of area = 2,475 (one other part time dentist in town), most of my patients come from surrounding county (outside city limits). I am forty miles from the biggest city in the state, lots of people are starting to move in my direction to get out of the city. The population of the county is around 48,000.

2) The previous owner that retired worked M-Thu from 8:00am-5:30pm and produced $1,022,000 (2016) and had a very low overhead of around 57%. He did well. We are on pace to do $1,450,000 for 2017.I obviously have a practice loan and lease that he didn't have to pay for. But I'm blessed to be still doing well. The way you pay yourself when you get out (so it's to your advantage with student loans, tax write-offs, etc.) is to setup an S-Corporation that owns your practice. Mine is named "Doctor's name, DDS, PA." You can pay yourself as much or as little as you like. To answer your question, my overhead is probably around 62% due to my practice loan, lease payment, etc. I plan to purchase the building soon through my LLC that I formed, so it'll go down with that. My lease is 3k per month, mortgage will be $1,500.

3) To be quite honest, this practice is busting at the seams to grow. There isn't hardly any time to do much besides basic stuff. I only do basic restorative (fillings), extractions (no 3rds--another source of growth possibly), crowns/bridges, dentures, implant (I restore them for now) crowns. I'm planning to go to an implant continuum soon called Engel Institute, supposed to be VERY good. No endo, but I plan to do anterior and premolar endo in the near future. His office wasn't setup for it, so I'm getting set in before I buy more equipment. Molar endo IMO is very difficult and less predictable, and way less profitable...so I refer those out to the endodontist. I plan to start keeping anteriors/premolars in house by this summer.

4) I picked the practice I did because everything lined up for me, I got lucky. I learned to network with the supply reps (Patterson Dental) at my associateship position. As soon as they heard of this doctor retiring, they immediately let me know and the rest is history. Took me around 8 months do all my research, get approval from the banks, setup everything, etc. It's A LOT of work. The things that were very important to me in searching for a practice were:

A) Potential growth-this practice is obviously waiting to explode growth wise
B) Little to no insurance involvement (not in network with lots of insurances)
C) Little competition-which forces you to go rural---BUT as I said, I live 20 minutes from downtown Charlotte, NC and my practice is only 40 miles out of Charlotte.
D) Location-we wanted as close to a big city as possible (airports, wife wants to go back to get her PhD and become a principal), yet in an area where I feel like I have a big impact on the community.

5) I paid around 700k for the practice. That's about 68.5% of gross production of the previous year. They have lots of calculations they do to figure out what's fair...his CPA vs. my CPA. TBH, I didn't get involved that much with negotiations, my CPA did most of the work. We started negotiations at 680k and they started at 775k, if that means anything to you. I played hardball and acted as if I were backing out for a couple weeks, the seller contacted me saying "I'm ready to make a deal." Typically, practices in rural areas sell for around 60 to 70% of the gross production for the past year (the easiest calculation I've come up with). Since this one was so insurance/cash base friendly, it valued out to be a little on the higher end. I've seen some practices in super competitive areas sell for up to 110% of gross, which is absolutely stupid and insane to me (Charleston, SC for example). EVERYONE wants to practice there for some reason... if you move there, you'll be forced to be in network with every insurance known to mankind. My crown fee is $993 and I get every dollar of that. Those dentists in those areas get (if lucky) around $650 for crowns. After a $200 lab fee and impression materials/supplies...there's a lot less room for profit.

I hope this helps a little.

 

[CanaDMD]

I'm a D2.

How do you get to the point in your career of being confident enough and fully going out on your own? Tx planning, how do you know ur making the right call? Howd u develop speed/skills?

I'm worried that I'm not gonna be fast enough come D4 to be profitable in real life? If that makes sense?

 

[LLUDDS15]

I'm a D2.

How do you get to the point in your career of being confident enough and fully going out on your own? Tx planning, how do you know ur making the right call? Howd u develop speed/skills?

I'm worried that I'm not gonna be fast enough come D4 to be profitable in real life? If that makes sense?

So you'll never be 100% confident, and if you are that's an issue to talk about another day. Right now, you are learning basics without really understanding the "why" behind it all. I assume you're starting on dental classes by now and taking labs where you do crown preps, temps, dentures, etc. Always be honest with yourself, there's nothing wrong with taking impressions on a patient and studying them after hours with some of the data you've collected to make the decision best for them. One GREAT resource I wish I'd known about in dental school is dentaltown.com. They have some of the best dentists in the world there and are always willing to give advice to anyone that's willing to post.

The way I think about tx planning is "if it were me, what would I want done to my mouth?" Sometimes finances dictate which direction you go, i.e. Implants Vs. RPDs, etc. Some people will pay any price to not have to take something "in and out" of their mouths. Mainly, you have to listen to your patient and see what they want, don't just assume. Always give them all of their options when making a major decision (full mouth extractions leading to a denture or implant-supported denture). Give them time, I always let them think about it for a week or so and get back to me. My front desk will kindly follow up with them, if you push them right away, it makes you look aggressive and non-empathetic to their situation. The hardest cases to me are the ones that are in the middle, meaning do I extract due to hopeless perio condition of the teeth or do I hope they change their habits and keep status quo or slightly improve. If you have a particular scenario, I'd be happy to offer my advice to you.

Speed and skills-to be honest, it just comes with time. I was so nervous to do anything in school and right out of school. It took me longer to do good work, but I always assured the patient that while it took a bit longer, I was giving them the best treatment I possibly could. 100% of them understand and respect you not doing shoddy work in their mouths. As you attend CE (get going on it now btw) courses, you'll learn a lot of methods for doing procedures that are way quicker. For example, for crown preps, I use Mike DiTolla from Glidewell Labs Reverse Crown Prep technique. Margins turn out perfect every single time and it takes 1/4 the amount of time with the depth cut burs. No guesswork at all. Try to practice some of these techniques in school, this is one thing I wish I'd done more of instead of thinking I could only use the technique and burs they suggested. In dental school (I'm sure you know this already, or will learn it soon)...things are made as complicated as humanly possible. If you think creatively and outside the box, you can make life a little easier on yourself, like the example above.

Your comment about not being fast enough as a D4 absolutely makes sense. It's good that you're able to know your limits. Take 1 year and do an associateship straight out of school. I highly recommend it. You will not make as much as you potentially can, but it teaches you a lot. During this time, you can be getting quicker (while keeping good quality of work of course) and learn the ins and outs of how a dental office functions. Ask the insurance lady in the practice you work in to explain that stuff to you, as a practice owner...you must know all this stuff and understand reports like accounts receivable (A/R), aging report, day sheets, etc. It's your duty to make sure every single penny is accounted for. Learn who to order supplies from to lower your overhead. Make a list of things a practice MUST HAVE for you to be happy and even throw in some dream items. Start networking with the supply reps (Patterson, Henry Schein, etc---not sure where you are) in your D4 year in the area you plan to practice/acquire. Lots of times they are the first ones to know of potential good aasociateships and retiring docs wanting to sell their practices soon.

Does this make sense?

 

[SnozzBerry]

1) Population of area = 2,475 (one other part time dentist in town), most of my patients come from surrounding county (outside city limits). I am forty miles from the biggest city in the state, lots of people are starting to move in my direction to get out of the city. The population of the county is around 48,000.

2) The previous owner that retired worked M-Thu from 8:00am-5:30pm and produced $1,022,000 (2016) and had a very low overhead of around 57%. He did well. We are on pace to do $1,450,000 for 2017.I obviously have a practice loan and lease that he didn't have to pay for. But I'm blessed to be still doing well. The way you pay yourself when you get out (so it's to your advantage with student loans, tax write-offs, etc.) is to setup an S-Corporation that owns your practice. Mine is named "Doctor's name, DDS, PA." You can pay yourself as much or as little as you like. To answer your question, my overhead is probably around 62% due to my practice loan, lease payment, etc. I plan to purchase the building soon through my LLC that I formed, so it'll go down with that. My lease is 3k per month, mortgage will be $1,500.

3) To be quite honest, this practice is busting at the seams to grow. There isn't hardly any time to do much besides basic stuff. I only do basic restorative (fillings), extractions (no 3rds--another source of growth possibly), crowns/bridges, dentures, implant (I restore them for now) crowns. I'm planning to go to an implant continuum soon called Engel Institute, supposed to be VERY good. No endo, but I plan to do anterior and premolar endo in the near future. His office wasn't setup for it, so I'm getting set in before I buy more equipment. Molar endo IMO is very difficult and less predictable, and way less profitable...so I refer those out to the endodontist. I plan to start keeping anteriors/premolars in house by this summer.

4) I picked the practice I did because everything lined up for me, I got lucky. I learned to network with the supply reps (Patterson Dental) at my associateship position. As soon as they heard of this doctor retiring, they immediately let me know and the rest is history. Took me around 8 months do all my research, get approval from the banks, setup everything, etc. It's A LOT of work. The things that were very important to me in searching for a practice were:

A) Potential growth-this practice is obviously waiting to explode growth wise
B) Little to no insurance involvement (not in network with lots of insurances)
C) Little competition-which forces you to go rural---BUT as I said, I live 20 minutes from downtown Charlotte, NC and my practice is only 40 miles out of Charlotte.
D) Location-we wanted as close to a big city as possible (airports, wife wants to go back to get her PhD and become a principal), yet in an area where I feel like I have a big impact on the community.

5) I paid around 700k for the practice. That's about 68.5% of gross production of the previous year. They have lots of calculations they do to figure out what's fair...his CPA vs. my CPA. TBH, I didn't get involved that much with negotiations, my CPA did most of the work. We started negotiations at 680k and they started at 775k, if that means anything to you. I played hardball and acted as if I were backing out for a couple weeks, the seller contacted me saying "I'm ready to make a deal." Typically, practices in rural areas sell for around 60 to 70% of the gross production for the past year (the easiest calculation I've come up with). Since this one was so insurance/cash base friendly, it valued out to be a little on the higher end. I've seen some practices in super competitive areas sell for up to 110% of gross, which is absolutely stupid and insane to me (Charleston, SC for example). EVERYONE wants to practice there for some reason... if you move there, you'll be forced to be in network with every insurance known to mankind. My crown fee is $993 and I get every dollar of that. Those dentists in those areas get (if lucky) around $650 for crowns. After a $200 lab fee and impression materials/supplies...there's a lot less room for profit.

I hope this helps a little.

Thank you very much for the thorough reply, it's definitely helpful! Congrats on your success and best of luck in the future !

 

[CanaDMD]

So you'll never be 100% confident, and if you are that's an issue to talk about another day. Right now, you are learning basics without really understanding the "why" behind it all. I assume you're starting on dental classes by now and taking labs where you do crown preps, temps, dentures, etc. Always be honest with yourself, there's nothing wrong with taking impressions on a patient and studying them after hours with some of the data you've collected to make the decision best for them. One GREAT resource I wish I'd known about in dental school is dentaltown.com. They have some of the best dentists in the world there and are always willing to give advice to anyone that's willing to post.

The way I think about tx planning is "if it were me, what would I want done to my mouth?" Sometimes finances dictate which direction you go, i.e. Implants Vs. RPDs, etc. Some people will pay any price to not have to take something "in and out" of their mouths. Mainly, you have to listen to your patient and see what they want, don't just assume. Always give them all of their options when making a major decision (full mouth extractions leading to a denture or implant-supported denture). Give them time, I always let them think about it for a week or so and get back to me. My front desk will kindly follow up with them, if you push them right away, it makes you look aggressive and non-empathetic to their situation. The hardest cases to me are the ones that are in the middle, meaning do I extract due to hopeless perio condition of the teeth or do I hope they change their habits and keep status quo or slightly improve. If you have a particular scenario, I'd be happy to offer my advice to you.

Speed and skills-to be honest, it just comes with time. I was so nervous to do anything in school and right out of school. It took me longer to do good work, but I always assured the patient that while it took a bit longer, I was giving them the best treatment I possibly could. 100% of them understand and respect you not doing shoddy work in their mouths. As you attend CE (get going on it now btw) courses, you'll learn a lot of methods for doing procedures that are way quicker. For example, for crown preps, I use Mike DiTolla from Glidewell Labs Reverse Crown Prep technique. Margins turn out perfect every single time and it takes 1/4 the amount of time with the depth cut burs. No guesswork at all. Try to practice some of these techniques in school, this is one thing I wish I'd done more of instead of thinking I could only use the technique and burs they suggested. In dental school (I'm sure you know this already, or will learn it soon)...things are made as complicated as humanly possible. If you think creatively and outside the box, you can make life a little easier on yourself, like the example above.

Your comment about not being fast enough as a D4 absolutely makes sense. It's good that you're able to know your limits. Take 1 year and do an associateship straight out of school. I highly recommend it. You will not make as much as you potentially can, but it teaches you a lot. During this time, you can be getting quicker (while keeping good quality of work of course) and learn the ins and outs of how a dental office functions. Ask the insurance lady in the practice you work in to explain that stuff to you, as a practice owner...you must know all this stuff and understand reports like accounts receivable (A/R), aging report, day sheets, etc. It's your duty to make sure every single penny is accounted for. Learn who to order supplies from to lower your overhead. Make a list of things a practice MUST HAVE for you to be happy and even throw in some dream items. Start networking with the supply reps (Patterson, Henry Schein, etc---not sure where you are) in your D4 year in the area you plan to practice/acquire. Lots of times they are the first ones to know of potential good aasociateships and retiring docs wanting to sell their practices soon.

Does this make sense?

This does make sense, thank you.

I am in Canada, so any specific advice to add would be great.

One thing : you think I should be doing CE now? Also, how do I evaluate disability insurance correctly?

 

[LLUDDS15]

This does make sense, thank you.

I am in Canada, so any specific advice to add would be great.

One thing : you think I should be doing CE now? Also, how do I evaluate disability insurance correctly?

I'm not really sure about the demographics in Canada tbh. Absolutely, whenever you have a chance...do as much CE as possible in dental school to expand your knowledge. You're pretty smothered right now, but as you get into late D3 and D4 (think you said you're a D2, right?) it becomes a lot more doable. Courses I highly recommend are anything by Pankey Institute (in FL), Dawson Academy, Scott Leune Business Masters (going again April 5) in San Antonio, TX, Spear (in AZ), Kois Center (Seattle, WA), and Invisalign. For implants, I HIGHLY recommend Engel Institute in Charlotte, NC (I think they have multiple locations), take an Invisalign course and become a certified provider. WaveOne Endo is what I plan to use whenever I get time to go for the course. Gordon Christensen has some really good CE courses (online and in person).

 

[periopocket]

Congratulations! I've been meeting more and more successful LLU docs! They must be good clinicians!


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[LLUDDS15]

Congratulations! I've been meeting more and more successful LLU docs! They must be good clinicians!

I'm not a big believer in schools dictating your success tbh. I absolutely love my alma mater and had a great experience there (for the most part), but most of what you learn with respect on how to be successful in private practice..you learn on the outside after school during your associateship. Loma Linda is undoubtedly a good clinical experience, though. We had (at the time, not sure about now) some of the most case requirements of any other schools. They made us do everything (set our own denture teeth, wax up our own crowns, etc.) and while I think that stuff is somewhat important...what's more important is teaching students the new technology that's available to them in 2017 and beyond. We didn't really learn a lot about implants (not sure any predoc programs do) but I think this should be an area of improvement for dental schools. When I was leaving, they were pushing the CEREC machines more and more on clinic, so that's a good thing to see. Not many will set their own denture teeth or wax up their own crowns, there's just not time to do that anymore, and it's quite the waste of time.

 

[italianstallion2008]

Current D3. Thanks so much for creating this thread.

At what point during dental school did you begin seeking out an associateship and how did you go about finding the right fit?
Do you/to what extent do you utilize EFDA?
How big is your staff and what type of turnover did you have during the practice transition (staff/patients)?
Was the office you purchased already pretty contemporary with respect to technology and what type of advances (Cerec, digital dentistry, new ops, chairs, equipment, etc.) do you feel you need to make/how important does that seem to be to your patient base in a rural community?


Thank you so much again.

 

[LLUDDS15]

Current D3. Thanks so much for creating this thread.

At what point during dental school did you begin seeking out an associateship and how did you go about finding the right fit?
Do you/to what extent do you utilize EFDA?
How big is your staff and what type of turnover did you have during the practice transition (staff/patients)?
Was the office you purchased already pretty contemporary with respect to technology and what type of advances (Cerec, digital dentistry, new ops, chairs, equipment, etc.) do you feel you need to make/how important does that seem to be to your patient base in a rural community?


Thank you so much again.

1) I would say that I began my search for an associateship about halfway through D4 year. In retrospect, I wish I'd communicated with the supply reps in the area in which I wanted to relocate. I'm in SC, but went to school in SoCal, that's a huge distance obviously. Network network, network!!! Contact dentists in the area you want to move to and tell them your situation, ask what the supply reps name is and get his/her contact info. They know firsthand of dentists looking for associates so that you don't get sucked into the AFTCOs and ETS and just tbh bad ones that have been picked over and aren't very good ones.

2) I actually have the same DAs the last doc hired. They're good for the most part, but they've had to unlearn his ways and learn mine. He's stayed on during the transition to help introduce me to the patients and to assure them of his confidence in me, etc. So it was crucial for that, in a small town, IMO. Once he's gone, I think things will be a lot better as far as training them just for me. They've done really well with the given circumstances though. One of my DAs is actually a hygienist/DA hybrid. We have two full time RDHs and whenever one of them has to be out, we just plug her in wherever need be. I pay her between a starting RDH and EFDA salary, but the flexibility is SUPER nice to have. To answer your question more directly, I let them place topical, make temp crowns, take impressions (alginate-for study models only), pack retraction cord, take all xrays, etc. Anything in particular you were wondering about?

3) The office is very outdated, but is nice and functional if that makes since. Formica counters, tile floors, etc. The things I'm wanting to upgrade to very soon are electric handpieces (NSK are my recommended ones), put 27" LED monitors in all 5 ops to show patients what/why they need the recommended treatment, and to get a digital scanner soon as well. He didn't do any endo, so I'd like to start doing the more profitable/quick, easy ones with the WaveOne technique. At some point, I'll probably place granite countertops, but that'll be down the road when I need to spend some money to lessen my tax hit.

 

[FutureJawBreaker]

How much invisalign and ortho do you do? Do you take insurance at all? Or is it all out of pocket for the pts?
I'm sorry if this is too personal but out of the 1.45 million that your practice will make this year, how much is your take home, having paid student/practice loans, staff etc....? Thanks again!


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[LLUDDS15]

How much invisalign and ortho do you do? Do you take insurance at all? Or is it all out of pocket for the pts?
I'm sorry if this is too personal but out of the 1.45 million that your practice will make this year, how much is your take home, having paid student/practice loans, staff etc....? Thanks again!


Sent from my iPhone using SDN mobile

I don't currently do any Invisalign, but plan to at some point if I ever get time. I may end up hiring an associate at some point, so I can focus more on doing implants and more involved procedures. Doing lots of fillings all day wears you OUT mentally.

I'd say my practice overhead is around 62% right now, so the rest of that is take home for me. It gets tricky paying yourself though, I personally do not own my practice, m S-corporation does. At some point when I buy the building, my LLC will own the building and land and I will "rent" the building from my LLC. It's all about spreading out your income.

I am not in network with ANY insurances I keep my fees low so that the same people will continue to come to me and pay out of network costs because they love the experience and treatment they get. I come out ahead not being in network, WAY ahead.

 

[CanaDMD]

I'm not really sure about the demographics in Canada tbh. Absolutely, whenever you have a chance...do as much CE as possible in dental school to expand your knowledge. You're pretty smothered right now, but as you get into late D3 and D4 (think you said you're a D2, right?) it becomes a lot more doable. Courses I highly recommend are anything by Pankey Institute (in FL), Dawson Academy, Scott Leune Business Masters (going again April 5) in San Antonio, TX, Spear (in AZ), Kois Center (Seattle, WA), and Invisalign. For implants, I HIGHLY recommend Engel Institute in Charlotte, NC (I think they have multiple locations), take an Invisalign course and become a certified provider. WaveOne Endo is what I plan to use whenever I get time to go for the course. Gordon Christensen has some really good CE courses (online and in person).

Yup, we're definitely getting hammered in D2 so hopefully in D3.

That being said, where am I supposed to get the $$$ to attend these events? xD

 

[LLUDDS15]

Yup, we're definitely getting hammered in D2 so hopefully in D3.

That being said, where am I supposed to get the $$$ to attend these events? xD

That's a good question, I had a nest egg built up because I had roommates in dental school-even then, it's very hard to come up with that much cash for a class. It's very expensive to you now, but I don't think you can afford not to go if you're planning to buy soon after dental school. Your ROI will be astronomical though, so that's a positive. Worst case scenario, you go when you're an associate and you can easily afford it then.

 

[Gold_Toof]

Very good insight thank you for taking the time to answer some of these questions. I'm about to be a D1 in the fall, with career aspirations very similar to what you're doing. What advice would you give to someone just about to start dental school? Many dentists have told me that there's so many real world skills/business acumen that are not learned in dental school. I would like to be ahead of the curve as much as I can.

 

[hopefuldentist123]

Did you ever consider specializing? What made you decide to stay in general dentistry?

 

[LLUDDS15]

Hey guys, I just got in from work and from my personal trainer killing me tonight. As soon as the weekend comes around, I'll respond to each of you individually. Cheers and keep up the fight!

 

[CanaDMD]

That's a good question, I had a nest egg built up because I had roommates in dental school-even then, it's very hard to come up with that much cash for a class. It's very expensive to you now, but I don't think you can afford not to go if you're planning to buy soon after dental school. Your ROI will be astronomical though, so that's a positive. Worst case scenario, you go when you're an associate and you can easily afford it then.

Oh okay I see. All the money I bring in and had b4 D1 helps/helped pay tuition/school fees, and the rest is covered by family finances. But I'd feel way too bad asking for more to attend these types of classes if I'm being honest? :s

I'm guessing those classes would have a higher ROI around end of D3 when I understand a lot more about dealing with patients anyways?

 

[periopocket]

I'm not a big believer in schools dictating your success tbh. I absolutely love my alma mater and had a great experience there (for the most part), but most of what you learn with respect on how to be successful in private practice..you learn on the outside after school during your associateship. Loma Linda is undoubtedly a good clinical experience, though. We had (at the time, not sure about now) some of the most case requirements of any other schools. They made us do everything (set our own denture teeth, wax up our own crowns, etc.) and while I think that stuff is somewhat important...what's more important is teaching students the new technology that's available to them in 2017 and beyond. We didn't really learn a lot about implants (not sure any predoc programs do) but I think this should be an area of improvement for dental schools. When I was leaving, they were pushing the CEREC machines more and more on clinic, so that's a good thing to see. Not many will set their own denture teeth or wax up their own crowns, there's just not time to do that anymore, and it's quite the waste of time.

I agree with you! Probably just coincidence. Thank you so much for your feedback and advice. Keep killin in!


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[Manic324]

Hey thanks for doing this! How were job prospects when you started looking 2 years ago? I understand you went rural but did you apply to any more urban locations as well and get offers? How about your classmates?

I keep hearing horror stories of fourth years not finding jobs for months and months

 

[Medin2017]

Hey Guys,

I used to frequent these boards when I was in your position looking for advice. I may not be the best person to ask about DATs and NBDEs, but I have been in private practice for almost 2 years now, just bought my own practice about 6 months ago. It's been a hectic transition, but I LOVE having my own and being my own boss. I wanted to give back and try to help out wherever possible because I was in your position not long ago. Keep up the fight and perseverance, you will be more than happy when it's all over and done. Dentistry is absolutely the most rewarding career you could ever ask for.

Do you know how your friends are doing these days? Another dentist had an AMA and talked about like 10 of his friends and how they were doing (specialists and generalists alike).

 

[577455]

Would you recommend the NHSC Scholarship?

 

[super frank]

Would you recommend the NHSC Scholarship?

I also have a similar question... I will be attending an Ivy ultimately with the ambition to specialize at some point, however, the price tag is steep and I'm wondering if perhaps I should accept the scholarship (if rewarded) and maybe return to specialize following my commitment of four years... Also I don't know if returning to specialize will make sense, especially for OS, at such a late age.

What I guess I'm asking is should I forgo the scholarship (again, if awarded) and specialize (OS) with the debt instead. Is the income that OS pull really that much more significant that the debt will become less burdensome? I suppose it's also important to factor in those four years of OS income that would be missed with the scholarship.

 

[comatose]

Just to keep things in perspective here, this is one rural dentist's advice. You should keep that in mind when reading his experiences. He is not representative of most dentists.

 

[Scumbag_Steve]

.

 

[free99]

If the income is the main issue at play behind making your decision, you should do OS (private practice) and never look back.Even with the opportunity cost that the lost 4-6 years of income entails, and even if you go to a school with an extremely hefty price-tag, unless the market forces change dramatically you will come out on top having gone that route over NHSC.

You could always do residency after the NHSC commitment, but the likelihood of it fitting with your schedule/goals as well as potential wife and kids, it is less likely. Certainly not impossible. However, if income is the only (or even primary) determinant of which specialty you enter, you run the risk of putting yourself through a grueling and expensive (in terms of opportunity cost) residency program to limit yourself to practicing something you don't enjoy. That's always something to think about.

I agree with this to an extent with the caveat that no one really knows how they'll do in dental school. Gaining admission to an ivy, and getting the nhsc scholarships are both good indications that you have the commitment and drive that it takes to get into an omfs program. But who's to say you'd even end up liking the procedures that omfs do? The old "bird in hand" phrase is coming to mind here... The nhsc scholarship is one of the best deals out there, think long and hard before giving something like that up.

 

[Scumbag_Steve]

.

 

[LLUDDS15]

Oh okay I see. All the money I bring in and had b4 D1 helps/helped pay tuition/school fees, and the rest is covered by family finances. But I'd feel way too bad asking for more to attend these types of classes if I'm being honest? :s

I'm guessing those classes would have a higher ROI around end of D3 when I understand a lot more about dealing with patients anyways?

Absolutely! I completely understand, I'm a practice owner now and that's the only reason I can afford to do it. My parents would laugh at me if I asked for $2,600 for a two day class haha. It'll be WELL worth your money though.

 

[LLUDDS15]

Hey thanks for doing this! How were job prospects when you started looking 2 years ago? I understand you went rural but did you apply to any more urban locations as well and get offers? How about your classmates?

I keep hearing horror stories of fourth years not finding jobs for months and months

My job prospects were very good. When I started looking for a job, I knew that I didn't want to do chain/mill dentistry. I looked everywhere, but never really knew that online listings were sort of leftovers. I HIGHLY recommend networking with your area's Patterson/Henry Schein/or whatever major dental supply rep you have...to see if they know of docs needing associates. They know of the best opportunities first. Get to know them well, take care of them, etc...they'll hook you up.

If someone can't find a job for months and months, they aren't looking hard enough or willing to sacrifice on their location. There are tons of people needing associates, if things keep growing around my office, I may need one soon. If you want to be an associate in downtown San Diego, everyone wants that haha, so you'll never find work--and when you do, there's so much competition for your potential associateship, they can pay you pennies. Just my experience anyways, but to each his own, I understand each of us has different priorities.

 

[super frank]

I completely agree with you. The way the OP was phrasing things it seemed as if they were asking whether they should to the NHSC or specialize as a binary decision based on finances, so that's where I was coming from in addressing it. I couldn't agree more that this is not the best way to figure out what you would enjoy doing for a career.

Like you, I also am entering dental school with an interest in a specialty, and like you, I think/hope that the interest will be reaffirmed during dental school. If you had similar ambitions prior to matriculation, why can't I? I have shadowed OMFS, in addition to other specialties and general dentistry, and it is hands down the most interesting to me. My question was not based off of finances, it was based off of what would be the best way to handle my debt. I am just trying to make an informed decision. NHSC, or OMFS right out of school. Granted, this is a completely hypothetical question considering I have not received the scholarship, and I'm still a long way away from match day. The income that OMFS receive is nice, but that's just an added bonus to work that looks like I'd enjoy.

 

[Greyangel6]

Before dental school, I often fantasized about the day I match into endo residency. Now, in the spring of D2 year, with part I and final exams around the corner, I find the need to survive dental school outweighs any interest in specializing or socializing lol

 

[wengerout]

If the income is the main issue at play behind making your decision, you should do OS (private practice) and never look back.Even with the opportunity cost that the lost 4-6 years of income entails, and even if you go to a school with an extremely hefty price-tag, unless the market forces change dramatically you will come out on top having gone that route over NHSC.

You could always do residency after the NHSC commitment, but the likelihood of it fitting with your schedule/goals as well as potential wife and kids, it is less likely. Certainly not impossible. However, if income is the only (or even primary) determinant of which specialty you enter, you run the risk of putting yourself through a grueling and expensive (in terms of opportunity cost) residency program to limit yourself to practicing something you don't enjoy. That's always something to think about.

What do you mean by expensive in terms of opportunity cost? Even with the lost salary of those 3-4 years doesn't it make more sense to specialize if we are just analyzing things from a dollars perspective?


Sent from my iPhone using SDN mobile

 

[Scumbag_Steve]

.

 

[Scumbag_Steve]

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[LLUDDS15]

Seriously guys, I would just do whatever makes you happiest. Obviously, debt is a serious responsibility, but when you guys get out and start earning money..you'll be able to have a decent lifestyle as long as you live in moderation. You won't be NFL superstar rich, but you'll be able to afford decent things. I grew up dirt poor, so owning my own 250k home and having no car payments is huge to me, but relative to others in my class...that's skid row. I'm able to max out my IRA contributions every year and put a very decent amount into retirement savings, I have a 401k safe harbor matching plan at my office. I match up to 3% of their contributions and I'm allowed to contribute up to ~53k per year (S-corporation maximum). Bottom line, do what makes you happy. Regardless, you're waking up every morning with a ton of debt. You have to spend money to make money, it's always been the case.

 

[Medin2017]

Before dental school, I often fantasized about the day I match into endo residency. Now, in the spring of D2 year, with part I and final exams around the corner, I find the need to survive dental school outweighs any interest in specializing or socializing lol

What caused you to be in this situation? I've seen posts on the med forums of people starting out barely passing then putting in 8 hr days and ending up in the top quarter or scoring 1 SD above the median every test. Did you decide it wasn't worth it, or did you try everything and still were overwhelmed?

 

[deleted696582]

Dentistry is absolutely the most rewarding career you could ever ask for.

Do you think dentistry is a rewarding career because you love the daily ins and outs of it? Or do you just enjoy the autonomy you have and financial flexibility? Or both?

 

[hopefuldentist123]

Would you live at home during dental school to save 20k on rent? My debt will be around 225k or so. I would like to live within walking distance of the school, but if I lived at home it would only be a 10 minute drive. I also would prefer to live on my own, but it will mean more debt.

 

[FlowerGirll35]

Would you live at home during dental school to save 20k on rent? My debt will be around 225k or so. I could like to live within walking distance of the school, but if I lived at home it would be a 10 minute drive. I would prefer to live on my own, but it will mean more debt.

Why won't your parents just get you a place next to school?

 

[LLUDDS15]

Do you think dentistry is a rewarding career because you love the daily ins and outs of it? Or do you just enjoy the autonomy you have and financial flexibility? Or both?

I'd say BOTH.

Mainly I enjoy the flexibility to travel with my wife and kids. At the end of April, we are going on a 2 week trip to Thailand. The old doc is going to cover while I'm gone, which is always good because those patients will get to still see him instead of someone new (random locum tenens). It's rewarding because it frees me up to go travel and see the world and to take CE classes in areas of dentistry I enjoy and/or need to improve upon. The key in dentistry is to ALWAYS know that you're not where you need to be and be humble enough to learn more, hungry to learn more. I love going into the office everyday knowing everyone has to make me happy, not the other way around...of course I don't abuse this, but it's just nice to know you have a job no matter what. I've never been able to travel like this, or afford to put so much money away into my retirement savings. When you guys graduate, you'll see how quick money comes and goes. Before I was a dentist (and right after school), I couldn't imagine how I'd pay a $7,300 practice payment. Now I barely even notice it being gone, probably because I'm used to it coming out. I've actually tried doubling up on payments the past couple, but it's tax season and I haven't been able to do that this month, plus my interest rate on my practice loan is ridiculously low (1.99% for 1st 3 years, 3.9 for last 7 years). My CPA just emailed me yesterday telling me to basically pay $12k in taxes for 2016 Q1 and Q4, or invest 18k in my SEP-IRA for 2016 + $5,500 for my Roth IRA and $5,500 for my wife's Roth IRA), and my tax hit would only be $6,200 if I maxed out my investments. I spend more, but that's a huge investment and I'm paying less to the government. It's amazing how you can move money around when you have a (S) corporation, so this is another benefit of owning your own practice.

The part I do not like is managing people. By nature, I'm a laid back type of guy and very non-confrontational. That's good most of the time, but there are definitely times where you need to professionally confront a staff member about an issue(s). Most of my staff have stayed on from the old doc, and they want to do things the exact way he used to. You can tell they are still sort of loyal to him. For the most part, that's fine since he was so successful and will be gone soon..you don't want to change too much too soon. BUT, anyone you take over for, you will have differences. For example, he just let them order whatever whenever without shopping around for supplies. They don't like that they have to submit whatever they need to me now, but it saves me probably 2k per month and I can use that towards paying down my practice loan quicker.

I'd say I love everything about this career except dealing with staff. I think once the old doc is gone for good (as an associate-he's down to 1 day per week now), things will improve a lot. So I'm just being patient, because him being there through this transition is absolutely important. My front desk (my wife + 2 other ladies) all tell me how patients ask, "is Dr. Old still there?" And it's nice for them to at least be able to say yes, but he's just slowing down. 99% of patients are ok with this, and continue to book their appointments normally, and once they meet me, they're willing to give me a shot. I haven't had one yet that didn't stay with us (to my knowledge, and we keep up with it pretty well).

 

[LLUDDS15]

Would you live at home during dental school to save 20k on rent? My debt will be around 225k or so. I would like to live within walking distance of the school, but if I lived at home it would only be a 10 minute drive. I also would prefer to live on my own, but it will mean more debt.

If you're only going to graduate with 225k from school, I'd live with your parents (if they are offering) and get the most flexible payback plan possible that doesn't penalize you for paying off early. This may be worth you going in and having a conversation with your student loan advisor. As you get the extra money, pay it down ASAP. Now days, that is not a lot of debt coming out of school, in fact it's way low. Live for 3 years coming out of school as cheap as possible, pay back like 75k per year (live on like ~50k, if you make more than ~125k---put the rest towards loans, not spending) and get some experience working as an associate, and in year 2 (of your associateship) get your ducks in a row to buy a great net cash flow practice that meets your needs/desires.

 

[deleted696582]

I'd say BOTH.

Mainly I enjoy the flexibility to travel with my wife and kids. At the end of April, we are going on a 2 week trip to Thailand. The old doc is going to cover while I'm gone, which is always good because those patients will get to still see him instead of someone new (random locum tenens). It's rewarding because it frees me up to go travel and see the world and to take CE classes in areas of dentistry I enjoy and/or need to improve upon. The key in dentistry is to ALWAYS know that you're not where you need to be and be humble enough to learn more, hungry to learn more. I love going into the office everyday knowing everyone has to make me happy, not the other way around...of course I don't abuse this, but it's just nice to know you have a job no matter what. I've never been able to travel like this, or afford to put so much money away into my retirement savings. When you guys graduate, you'll see how quick money comes and goes. Before I was a dentist (and right after school), I couldn't imagine how I'd pay a $7,300 practice payment. Now I barely even notice it being gone, probably because I'm used to it coming out. I've actually tried doubling up on payments the past couple, but it's tax season and I haven't been able to do that this month, plus my interest rate on my practice loan is ridiculously low (1.99% for 1st 3 years, 3.9 for last 7 years). My CPA just emailed me yesterday telling me to basically pay $12k in taxes for 2016 Q1 and Q4, or invest 18k in my SEP-IRA for 2016 + $5,500 for my Roth IRA and $5,500 for my wife's Roth IRA), and my tax hit would only be $6,200 if I maxed out my investments. I spend more, but that's a huge investment and I'm paying less to the government. It's amazing how you can move money around when you have a (S) corporation, so this is another benefit of owning your own practice.

The part I do not like is managing people. By nature, I'm a laid back type of guy and very non-confrontational. That's good most of the time, but there are definitely times where you need to professionally confront a staff member about an issue(s). Most of my staff have stayed on from the old doc, and they want to do things the exact way he used to. You can tell they are still sort of loyal to him. For the most part, that's fine since he was so successful and will be gone soon..you don't want to change too much too soon. BUT, anyone you take over for, you will have differences. For example, he just let them order whatever whenever without shopping around for supplies. They don't like that they have to submit whatever they need to me now, but it saves me probably 2k per month and I can use that towards paying down my practice loan quicker.

I'd say I love everything about this career except dealing with staff. I think once the old doc is gone for good (as an associate-he's down to 1 day per week now), things will improve a lot. So I'm just being patient, because him being there through this transition is absolutely important. My front desk (my wife + 2 other ladies) all tell me how patients ask, "is Dr. Old still there?" And it's nice for them to at least be able to say yes, but he's just slowing down. 99% of patients are ok with this, and continue to book their appointments normally, and once they meet me, they're willing to give me a shot. I haven't had one yet that didn't stay with us (to my knowledge, and we keep up with it pretty well).

Thanks for the detailed response. It's interesting how old staff are slow to change their ways, but it sounds like that won't be for long with you.

I like that traveling is definitely an option when you're a dentist. My ideal lifestyle after my Navy payback would be travel and extreme sport heavy, with dentistry supplementing things along the way.

 

[Greyangel6]

What caused you to be in this situation? I've seen posts on the med forums of people starting out barely passing then putting in 8 hr days and ending up in the top quarter or scoring 1 SD above the median every test. Did you decide it wasn't worth it, or did you try everything and still were overwhelmed?

Sorry to hijack the thread just a bit, but my schedule kinda sucks this spring, I got 7 final exams (4 of which are cumulative) for the finals' week, then we have at most 2 weeks of no school to study for part 1. After the 2 weeks, we get back to studying for clinical entrance (3 parts: oral exam, written exam, psychomotor exams). I think I will be fine, hopefully. But yea, this thread gives me hope that there's a light at the end of the tunnel haha.

 

[Medin2017]

Sorry to hijack the thread just a bit, but my schedule kinda sucks this spring, I got 7 final exams (4 of which are cumulative) for the finals' week, then we have at most 2 weeks of no school to study for part 1. After the 2 weeks, we get back to studying for clinical entrance (3 parts: oral exam, written exam, psychomotor exams). I think I will be fine, hopefully. But yea, this thread gives me hope that there's a light at the end of the tunnel haha.

So you still have an interest in specializing, but right now you're bogged down? Good luck it will all soon come to pass.

 

[Incis0r]

B) Little to no insurance involvement (not in network with lots of insurances)

Thank you for creating this AMA, Dr.!

I have a two-part question. You mention that your practice is largely FFS.

1) Do you find it easy to attract new patients/grow the practice when they have to pay out of pocket?
2) Do you believe this is a viable model for the future, or do you believe that you're in a unique situation?

 

[kindascared]

Hey Guys,

I used to frequent these boards when I was in your position looking for advice. I may not be the best person to ask about DATs and NBDEs, but I have been in private practice for almost 2 years now, just bought my own practice about 6 months ago. It's been a hectic transition, but I LOVE having my own and being my own boss. I wanted to give back and try to help out wherever possible because I was in your position not long ago. Keep up the fight and perseverance, you will be more than happy when it's all over and done. Dentistry is absolutely the most rewarding career you could ever ask for.

Thanks so much for the time you are putting into this!! I am pretty sure I speak for everyone here that it's greatly appreciated.
I have a quick question to ask you.
How any why did you choose to go to LLU? What do you think is the most important factor when considering where to go?

 

[LLUDDS15]

Thank you for creating this AMA, Dr.!

I have a two-part question. You mention that your practice is largely FFS.

1) Do you find it easy to attract new patients/grow the practice when they have to pay out of pocket?
2) Do you believe this is a viable model for the future, or do you believe that you're in a unique situation?

First of all, BOO Falcons haha! I didn't realize you had that as your avatar. I am a die hard Saints fan, which is odd living near Charlotte...but I grew up in MS and remember going to Saints games when only 1 of 10 seats were filled in the Superdome. I'm just giving you a hard time though, my best friend is a huge Falcons fan, so we're only friends from February through July. Anyways, to answer you questions...

1) I have my own little niche, it's JUST enough distance from the city for them to not want to have to fool with driving so far..yet close enough for me to commute to an area I love to live. My front desk tells me all the time that she thinks that's a major reason why people come, plus they get A+ service, we take great care of our patients. I get them glasses of cold water after long appointments, warm lavender scented face towels to wipe off after each appointment, lavender oil scents in the hallways and waiting rooms, coffee bar, etc. I'm still slowly upgrading the office to where it'll be a place they all love to come to...BUT I didn't want to change the identity of the office too quick without them knowing me first. Stuff like this takes time, and it's intelligent to slowly change things until you are where you want to be. My fee schedule is in the 50th percentile (maybe lower) so I've been advised by many (Scott Leune from Breakaway) to raise them up into the 70-80th percentile due to being booked out so far. I'm currently booked out for over 6 weeks, which is a blessing no doubt, BUT people don't like waiting that long to come in. Raising fees will make complainers leave, which is actually what we need.

2) I believe that it is a very viable model, as long as you don't move into an urban area that is saturated with dentists. If people feel like you treat them well vs. an assembly line...they will pay out of pocket to come to a dentist that takes his time and doesn't hurt them. My patient pool is very needy, they don't like any other dentists. We laugh, joke, and have a great time and I call them every night to check on their well-being. They absolutely love it. Today, I just got 7 new patients, this is about average since I've been there.

 

[LLUDDS15]

Thanks so much for the time you are putting into this!! I am pretty sure I speak for everyone here that it's greatly appreciated.
I have a quick question to ask you.
How any why did you choose to go to LLU? What do you think is the most important factor when considering where to go?

You're more than welcome! I chose LLU because it was the only school that I got into. If I had multiple to choose from, however, I would choose the one that gives me the absolute most clinical experience. I happened to be lucky enough to get that at LLU, but I think that's the most important factor. Next, if you're planning to specialize...go to a school that has a high residency match rate. I never had that intention, so it wasn't a factor for me. When you get to D3/4 you'll be beyond happy to just get out of there, trust me. My good friend in Dental School ended up matching to a 6yr OMFS/MD program. I still think he's crazy for going to school so long, but to each his own I guess.