Asking for a friend: Back to Ortho Residency?

[Mycoalwin]

Asking for a friend as he/she wanted to maintain anonymity:

"I’m currently a new graduate-practicing dentist in CA making an average income for a fresh grad. I’ve recently been considering orthodontics as a specialty and aware it may be harder now that I’m not in a school setting. I’m in the fortunate situation where I have family in the industry (one uncle in GP and one in Ortho) willing to have me take over their practices should I wish in a couple years. I fortunately do not have loans to worry about at the moment. Ownership / transition time point would happen roughly around 2023 for the GP practice or 2025 for Ortho, both are in relatively competitive areas but are doing well. 2-3 years of opportunity cost and tuition is what I’m considering if I were to pursue ortho.

Strictly financially speaking (assuming I do indeed like Ortho that much) - would the payoff and opportunity cost for Ortho be worth it assuming I go straight into my ortho uncle’s practice and eventually take over? Do Ortho-owners make that much more than GP-owners? What if I didn’t have my uncle’s ortho practice to walk into?"

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[FeralisExtremum]

Is the uncle handing them the practice for free, or expecting them to purchase it?

 

[Mycoalwin]

Is the uncle handing them the practice for free, or expecting them to purchase it?

To be honest I'm not sure my friend knows at the given moment. I guess assume either would be the same scenario of given vs purchased at fair value.

 

[011110]

I never understand these asking for a friend threads. Its an anonymous forum.

I have nothin else to add

 

[piratewow]

How competitive this person is will also directly affect the tuition/type of program they get accepted into. Ortho for 50k vs ortho for 300k is way different. What type of GP practice are they ( cosmetic, super-GP, restorative) and is that even suitable for the friend to run. My friend had a dentist offer to let him take over his practice but he changed his mind because the owner dentist was doing bread and butter RCT BU Crown all the time, but my friend wanted to do implants and cosmetics and refer/refuse the rest ( you would have to rebrand and lose a lot of the patient base).

More importantly, how good of a businessperson is your friend? A good business oriented GP can make way more than a poorly business oriented ortho. What if the GP uncle's practice only makes a lot because he is super fast and treats aggressively? What if the ortho uncle doesn't make that much but his day to day is way more chill?

There's honestly too many factors that you have not addressed to give "good advice". And I'm just a dental student. I'm sure actual practice owners have a lot more they would take into consideration.

 

[charlestweed]

If the owners are doing doing well, they don't usually sell their practices to someone else....they continue to work to make more money. Practices that are listed for sale are usually not good practices......high overhead, old equipment, fewer patients, empty appt book because the owners no longer put in the same energy and time as when they were younger. If the practice is doing well and the seller is forced to sell his practice (due to an illness, moving out of state etc), he usually asks for a very high selling price.....even if the seller is your uncle. Uncles are not the same as parents.

Your success as an orthodontist depends on many factors:
- Your relationship with referrring GP's. When you take over your uncle's practice, it's pretty much like starting an office from scratch. The existing referring GPs don't know who you are. You have to prove to these GPs that you are just as good or better than your uncle.
- How hard are you willing to work? When you are in a competitive area like in SoCal, you may have to lower the tx fee and reach out to low income population in order to fill your appt books. You may have to accept more insurance plans and open your office on Saturdays. This means that you have to see more patients per day and work longer hours to make up for the low fees.
- Your business skills. Are you willing to go door to door to meet referring dentists? Can you keep the overhead as low as possible? The less money you spend on rent, supplies, and staff salaries, the more money you will bring home.
- And most importantly, your clinical skills. The faster you are, the less assistants you will need to hire (save in overhead) and shorter amount of time it will take you to finish a case. Good clinical results will help bring more patients to your office. Poor clinical results will have the opposite effect. Remember your work will not only be evaluated by your patients but also by your referring GPs.

Ortho is a great specialty. The demand for ortho tx has actually increased during this Covid pandemic. My offices have started a lot more new cases this year than in previous years. Last Sunday (yes I work 3 Sundays a month), I started 8 new cases. I thought that was an awesome number. My P/T assistant, who also works P/T at another office, told me that the office she works at started 13 cases......my jaw dropped when I heard that. This increase is probably due to the stimulus aid from the government. Since most places are closed, people eat out less, travel less, cut their own hair at home etc...... they have more money in their pockets to pay for their kids' braces. The kids are still doing on-line studies at home; therefore, their parents can bring them in for ortho tx.

 

[2TH MVR]

Asking for a friend as he/she wanted to maintain anonymity:


Strictly financially speaking (assuming I do indeed like Ortho that much) - would the payoff and opportunity cost for Ortho be worth it assuming I go straight into my ortho uncle’s practice and eventually take over? Do Ortho-owners make that much more than GP-owners? What if I didn’t have my uncle’s ortho practice to walk into?"

Bottomline. Do ortho if you want to be an orthodontist. You enjoy ortho tx. IMO ortho is worth the lost opportunity costs (btw: I don't believe in this concept). Ortho has the best "working" lifestyle. You can practice longer. Procedures are easier. Patients are easier to work with. Staff does alot of the menial work. If you work in a Corp .... you will be paid almost double what the general dentists make. Ortho is fun. Less litigation.

Don't do ortho if you think you will make more money. Ortho is not the golden goose it once was. Especially in saturated areas like urban California. Kudos to @charlestweed for being successful in a very difficult environment. But I did not go into ortho to compete with low fees.

 

[charlestweed]

But I did not go into ortho to compete with low fees.

This is the common viewpoint among the orthodontists and orthodontic residents. They all want to target the same top 20% income earning population. The problem is the number of new grad orthos has increased rapidly (due to opening of new programs.....and programs like Georgia have added more seats to their programs) and the middle class in this country is shrinking. The size of the pie is getting smaller and it has to be cut into much smaller pieces. It's hard for orthodontists to thrive in rural areas because most high income earners, who can afford to pay for ortho tx, don't want to live those boring places.....they all want to live in big cities, where there are more fun things to do, where there are better private junior/high schools for their kids to attend, and where jobs are more abundant.

I fear my kids will have this same viewpoint after they graduate.....charge high fee, only work in a state-of-the-art facility, don't want to work for corp offices, don't accept insurance, fee for service only, don't want to work on the weekends, prefer the office to be overstaffed than being understaffed (so they don't have to work too hard) etc. That's why I encourage them to pursue medicine instead of dentistry/orthodontics. When they become doctors and work in a hospital, they can't really say no to working on the weekends and working past 6pm......they can't really say no to medicaid and other low pay insurances.....and they should make at least 2x as much as dentists, who work at the corp.