Corporate Dentistry is the Devil and the Profession is Dead..or is it?

[2TH MVR]

I thought GP's hired specialists in office to make it easier on their patients, so they could get their procedures in house. Maybe I'm just naive haha.

Also I see your point about why you chose to work in corporate. Could you go into more detail about what happened with the saturation? Did more ortho clinics open near you and start stealing your patients, lowering your referral base etc., yet overhead stayed the same?

And do you think this oversaturation problem will fix itself? By that I mean with the whole student loan bubble thing will there be less dentists graduating in the future?

There were always those GP offices that hired in house specialists, but they were not very common back in the early 90's. What I see now in PHX is many GP offices that advertise "____________ Dental Associates AND ORTHODONTICS. You see it everywhere. Not so much for the other dental specialities, but adding ORTHO has become the new GP tactic to attract more new patients and make more revenue. Easier for patients? Maybe. But I'm pretty sure it's profit motivated.

As for your 2nd point. MORE competition in the form of more orthodontists. More GP offices offering orthodontics. More CORPS. Referral GP's selling their practices to the CORPS, fees dropping, insurance pressing for lower ortho fees, less FFS, etc. etc. Again ... this is more obvious in the urban, saturated cities. Less so in the rural areas. I consider myself lucky that I sold my two practices ( I still own the building/office which I lease to the new ortho) and got out at the right time. Working for Corp is just a job that pays better than most know. It's still a **** show.

As for saturation. Regardless how many dentists graduate .... there will always be this trend for migration to the cities. Find a small town outside of a larger urban area to practice. Yes ... it is only a matter of time before a Corp moves in, but your chances of success will be better.

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[charlestweed]

Wouldn't you rather own your own practice than work for a corp boss with a HS diploma. This goes back to that saying that goes like "The people who got straight C's in college employ the people who got straight A's in college"
Seems unfair doesn't it?

I mean I see your point about not wanting to work for another orthodontist, that makes sense, but why would you want to work for a dude using private equity investments to hoard money?

That's what I did. I opened my first practice... and then the 2nd one, the 3rd one, and the 4th one with the hope that I could completely quit my job at the corp office. But then I realized that with the help of ortho assistants, I could easily do both: 11 days/month working at 4 of my offices and 10 days/month for 2 corp offices. Why let go an easy 6-figure job that only requires me to work 2 days/week...and stay home doing nothing? Who wouldn't want to be rich?

I never feel going through more schooling would make me more superior than a person who has less schooling than me. I never feel general dentists are beneath me because they have fewer years of education than me....in fact, I have to go around begging them for their referrals. There are specialists who work for general dentists. My corp boss (with a HS diploma) is better at doing certain things than me and I need her helps such as bringing in new patients for the office, pushing the staff to produce, hiring the right assistants to help me produce etc. I also have to treat my assistants with respect (and often take them out for lunch) because without their helps, I can't go home ontime.....the assistants are less helpful when they have to work with the doctor who is bossy. Bill Gates only has a HS diploma and a lot people with advanced degrees are working for him.

Even if I made less money and had more headaches, I would rather work for myself just based on principle.

Wait until you get out and have to pay back student loans while having to support your family. I think you will change your mind about working for people who have lower degree than yours.

A lot of dental students said they would never work for the evil corp. As soon as they faced with the student loan bills, they changed their mind....because they didn't have any choice.

 

[753698]

There were always those GP offices that hired in house specialists, but they were not very common back in the early 90's. What I see now in PHX is many GP offices that advertise "____________ Dental Associates AND ORTHODONTICS. You see it everywhere. Not so much for the other dental specialities, but adding ORTHO has become the new GP tactic to attract more new patients and make more revenue. Easier for patients? Maybe. But I'm pretty sure it's profit motivated.

As for your 2nd point. MORE competition in the form of more orthodontists. More GP offices offering orthodontics. More CORPS. Referral GP's selling their practices to the CORPS, fees dropping, insurance pressing for lower ortho fees, less FFS, etc. etc. Again ... this is more obvious in the urban, saturated cities. Less so in the rural areas. I consider myself lucky that I sold my two practices ( I still own the building/office which I lease to the new ortho) and got out at the right time. Working for Corp is just a job that pays better than most know. It's still a **** show.

As for saturation. Regardless how many dentists graduate .... there will always be this trend for migration to the cities. Find a small town outside of a larger urban area to practice. Yes ... it is only a matter of time before a Corp moves in, but your chances of success will be better.

All in all do you think corporate expansion is inevitable? And if so how much of the market share do you think it will take up?

I'm assuming there's going to be atleast some private or small group dental practices remaining even after corporate dental expansion, but these practices will be geared more towards luxury and better experience for the patient, so in general lower income patients will go to corp and higher income patients will go to the few private practices. I think I've heard it referred to as "concierge dentistry". Basically your Whole Foods higher quality higher prices compared to corp Walmart. I'm guessing that private practice will have to be based entirely on cash in the future since cuts in insurance reimbursements will make the procedures unsustainable, where overhead is higher than income.

 

[753698]

That's what I did. I opened my first practice... and then the 2nd one, the 3rd one, and the 4th one with the hope that I could completely quit my job at the corp office. But then I realized that with the help of ortho assistants, I could easily do both: 11 days/month working at 4 of my offices and 10 days/month for 2 corp offices. Why let go an easy 6-figure job that only requires me to work 2 days/week...and stay home doing nothing? Who wouldn't want to be rich?

I never feel going through more schooling would make me more superior than a person who has less schooling than me. I never feel general dentists are beneath me because they have fewer years of education than me....in fact, I have to go around begging them for their referrals. There are specialists who work for general dentists. My corp boss (with a HS diploma) is better at doing certain things than me and I need her helps such as bringing in new patients for the office, pushing the staff to produce, hiring the right assistants to help me produce etc. I also have to treat my assistants with respect (and often take them out for lunch) because without their helps, I can't go home ontime.....the assistants are less helpful when they have to work with the doctor who is bossy. Bill Gates only has a HS diploma and a lot people with advanced degrees are working for him.

Wait until you get out and have to pay back student loans while having to support your family. I think you will change your mind about working for people who have lower degree than yours.

A lot of dental students said they would never work for the evil corp. As soon as they faced with the student loan bills, they changed their mind....because they didn't have any choice.

Yeah I know what you mean. I don't really feel superior, it's more that I don't want to work for someone who hasn't worked as hard as me to get where they are. In other words, I'm salty that I would be working for someone who coasted through college, got a cushy job because of their "connections" and now get to boss me around. As a student I see those types everyday on campus and I would rather eat my toenails than work for them. It's why I really liked Dentistry as a profession because you get to be your own boss. Don't want that to change.

Fortunately though I shouldn't have much student loans, and shouldn't have family expenses to worry about either so I will probably be able to take more risks financially and also have better leverage than some of my peers. I'll probably have to model my practice differently though compete with corp, offer things they don't. But I should be able to experiment since I don't have other financial obligations.

 

[2TH MVR]

All in all do you think corporate expansion is inevitable? And if so how much of the market share do you think it will take up?

I'm assuming there's going to be atleast some private or small group dental practices remaining even after corporate dental expansion, but these practices will be geared more towards luxury and better experience for the patient, so in general lower income patients will go to corp and higher income patients will go to the few private practices. I think I've heard it referred to as "concierge dentistry". Basically your Whole Foods higher quality higher prices compared to corp Walmart. I'm guessing that private practice will have to be based entirely on cash in the future since cuts in insurance reimbursements will make the procedures unsustainable, where overhead is higher than income.

Corps want large patient pool numbers. Corps are located in large, urban areas. Want to avoid Corporate? Go where they don't go. Simple.

If you choose large, urban areas to open your practice. You will be competing with the Corp practices. Large and small. That's reality. It's not that you won't be successful .... it's just it won't be as EASY as it once was without the Corp's presence.

Concierge dentistry? Heartland Dental Corp has that covered. They buy, start and operate what appear to be private dental practices, but in reality are Corp owned. I believe they have the largest number of Corp practices in the US.

It's not all doom and gloom. Just go where the Corps don't want to go. Earn a better living than your urban counterparts and have the $$$$ to vacation in the nice areas.

 

[charlestweed]

Yeah I know what you mean. I don't really feel superior, it's more that I don't want to work for someone who hasn't worked as hard as me to get where they are. In other words, I'm salty that I would be working for someone who coasted through college, got a cushy job because of their "connections" and now get to boss me around. As a student I see those types everyday on campus and I would rather eat my toenails than work for them. It's why I really liked Dentistry as a profession because you get to be your own boss. Don't want that to change.

Fortunately though I shouldn't have much student loans, and shouldn't have family expenses to worry about either so I will probably be able to take more risks financially and also have better leverage than some of my peers. I'll probably have to model my practice differently though compete with corp, offer things they don't. But I should be able to experiment since I don't have other financial obligations.

Of course, being one's own boss should be the ultimate goal of every dentist. Nobody wants to work for someone else. The problem is not everybody has the right skills neccessary to run a successful practice. Not every new grad dentist, who has zero clinical experience and limited business skill, is brave enough to borrow a couple of hundred grands to set up (or to purchase) his/her own office.

It's not as bad as you think. I treat my boss as an equal. I first knew her when she worked with me as my ortho assistant at a corp. With her great communication skills and hard work, she got promoted to become a TC, then to an office manager position....and now she is the specialty director for a region that has around 15 offices. Sure, my boss can let me go anytime but she and the corp office need me more than I need them. It's not easy to replace an orthodontist, who can produce, who doesn't whine, and who has a long track record of doing good work. I've been at this same corp office for a long time. A lot of patients don't know that it's a corp run office and they think I am the owner. I don't need to ask my boss' permission to take vacations. I tell her the days I will be out of town and she has to find a sub doctor to cover for me. My boss has to ask my permission whether I can work on this day or that day and I have to approve it. Since she is clueless about things that are clinically related, I have full autonomy in making all treatment decisions. Her job is to deal with all the non-clinical stuff such as billings, schedulings, handling patient complaints, staff hirings/firings, equipment repairs etc. That's less headache for me. If you run your own office, you have to deal with both clinical and non-clinical stuff. That's why I can't let go this easy job that pays well...it's like having a vacation working here...it's better than staying home, eating, getting fat, and feeling useless.

I also get paid more than my boss. My job is more secured than my boss. If the office fails to meet goal, my boss will be the first one (and not me), who will bee let go by her higher boss. In 15+ years, I've seen the corp replacing people at her position 5-6 times.

That's my experience at the corp I work for. Diferent corps run things differently. Different dentists expect different things. Some dentists love the corp they work for while others may hate it.

 

[753698]

Corps want large patient pool numbers. Corps are located in large, urban areas. Want to avoid Corporate? Go where they don't go. Simple.

If you choose large, urban areas to open your practice. You will be competing with the Corp practices. Large and small. That's reality. It's not that you won't be successful .... it's just it won't be as EASY as it once was without the Corp's presence.

Concierge dentistry? Heartland Dental Corp has that covered. They buy, start and operate what appear to be private dental practices, but in reality are Corp owned. I believe they have the largest number of Corp practices in the US.

It's not all doom and gloom. Just go where the Corps don't want to go. Earn a better living than your urban counterparts and have the $$$$ to vacation in the nice areas.

Aren't corps eventually gonna go to those areas too though? I still have about 6 years till I will be done with D school theoretically, and probably 7-8 years till I purchase a practice. At the rate of corporate expansion won't they have pretty much covered every sector in about a decade? And what happens if they eventually do come into your area? Eventually you're gonna have to stand up to them right? Can't just let them bully you, and can't run away forever.

I was never planning on practicing in a big city anyways, too much competition, plus I don't wanna deal with irritating city people. And I feel like I won't be accepted into really rural communities since in general from what I know they tend to be really conservative and caucasian, and I'm asian. Not sure how they would take to having a non white dentist, whether they would trust me or not etc. Practicing in a suburb type of area would probably have been my ideal scenario but I see corp practices in the burbs already.

In fact, right now I'm in a small college town and there are corp practices here too! Aspen dental to be precise. I'm sure there's more also. This is pretty rural I gotta admit, I'm in the middle of nowhere.
Corps follow the money, and I think they've caught on that rural areas got some good money too.

 

[753698]

Of course, being one's own boss should be the ultimate goal of every dentist. Nobody wants to work for someone else. The problem is not everybody has the right skills neccessary to run a successful practice. Not every new grad dentist, who has zero clinical experience and limited business skill, is brave enough to borrow a couple of hundred grands to set up (or to purchase) his/her own office.

It's not as bad as you think. I treat my boss as an equal. I first knew her when she worked with me as my ortho assistant at a corp. With her great communication skills and hard work, she got promoted to become a TC, then to an office manager position....and now she is the specialty director for a region that has around 15 offices. Sure, my boss can let me go anytime but she and the corp office need me more than I need them. It's not easy to replace an orthodontist, who can produce, who doesn't whine, and who has a long track record of doing good work. I've been at this same corp office for a long time. A lot of patients don't know that it's a corp run office and they think I am the owner. I don't need to ask my boss' permission to take vacations. I tell her the days I will be out of town and she has to find a sub doctor to cover for me. My boss has to ask my permission whether I can work on this day or that day and I have to approve it. Since she is clueless about things that are clinically related, I have full autonomy in making all treatment decisions. Her job is to deal with all the non-clinical stuff such as billings, schedulings, handling patient complaints, staff hirings/firings, equipment repairs etc. That's less headache for me. If you run your own office, you have to deal with both clinical and non-clinical stuff. That's why I can't let go this easy job that pays well...it's like having a vacation working here...it's better than staying home, eating, getting fat, and feeling useless.

I also get paid more than my boss. My job is more secured than my boss. If the office fails to meet goal, my boss will be the first one (and not me), who will bee let go by her higher boss. In 15+ years, I've seen the corp replacing people at her position 5-6 times.

That's my experience at the corp I work for. Diferent corps run things differently. Different dentists expect different things. Some dentists love the corp they work for while others may hate it.

Your corp is definitely a lot better than the stories I've heard from others online. Also as an orthodontist your experience is probably a lot better. You aren't replaceable, but think of a GP. They are rather easily replaceable right, considering a surplus of GP's are pumped out of schools every year, as compared to a limited number of orthodontists since there are limited residency spots.

Also another point I would like to make is that as an owner GP, your growth potential is limitless. A good business mind can probably grow a practice very large, expand to multiple locations etc. Whereas working at a corp your ceiling is limited, limited to the amount you can produce. As an owner, you can reach the point where everything runs smoothly without you and you can be even be an absentee owner, possibly when you are reaching the point of retirement. No chance of doing that as an employee at a corp.

 

[2TH MVR]

Aren't corps eventually gonna go to those areas too though? I still have about 6 years till I will be done with D school theoretically, and probably 7-8 years till I purchase a practice. At the rate of corporate expansion won't they have pretty much covered every sector in about a decade? And what happens if they eventually do come into your area? Eventually you're gonna have to stand up to them right? Can't just let them bully you, and can't run away forever.

I was never planning on practicing in a big city anyways, too much competition, plus I don't wanna deal with irritating city people. And I feel like I won't be accepted into really rural communities since in general from what I know they tend to be really conservative and caucasian, and I'm asian. Not sure how they would take to having a non white dentist, whether they would trust me or not etc. Practicing in a suburb type of area would probably have been my ideal scenario but I see corp practices in the burbs already.

In fact, right now I'm in a small college town and there are corp practices here too! Aspen dental to be precise. I'm sure there's more also. This is pretty rural I gotta admit, I'm in the middle of nowhere.
Corps follow the money, and I think they've caught on that rural areas got some good money too.

Hey. Welcome to the club. I'm half Asian. Seriously.... You shouldn't worry about that issue.

You are correct that eventually the Corps will start opening in rural areas, but not to the extent of a saturated, urban city.

Also.... in a rural setting ... You will be better able to DIFFERENTIATE your private practice from the Corps. More community involvement. Marketing to show how your private practice is more service and patient oriented as compared to the for profit Corps. You can do this!

 

[princeafrica]

More community involvement. Marketing to show how your private practice is more service and patient oriented as compared to the for profit Corps. You can do this!

My mentor's dental practice holds a giant free community health fair every year in the summer with bouncy houses, face paint, etc for kids and parents. They have giveaways like flat screen TVs and video game consoles. Hawaiian dancing. She tells me it has helped her practice tremendously so the huge cost is returned. I volunteered last summer and there was over 1000 in attendance

 

[charlestweed]

Your corp is definitely a lot better than the stories I've heard from others online. Also as an orthodontist your experience is probably a lot better. You aren't replaceable, but think of a GP. They are rather easily replaceable right, considering a surplus of GP's are pumped out of schools every year, as compared to a limited number of orthodontists since there are limited residency spots.

There is a surplus of orthodontists as well, especially here in CA. Just do a quick search on this forum and you will see a of posts about new grad orthodontists who couldn't find work after they finished their ortho residency. Specialists and GPs are equally easily replaceable if they can't produce, can't handle busy schedule, have poor clinical skills, and get too complaints from patients. I had worked for 3 different corps (Western Dental, SmileCare, Brightnow) in the past. And the reason for these corps to hire me was to replace the previous orthodontists who under-performed.

The managing GP, who works at the same corp with me, has worked here for 10+ years. Every year, the corp gives her an award for being the top producing GP in the region. Because she is good, the manager usually saves all difficult and high production cases for her to perform and assign easier cases for other GPs in the corp to perform. Currently, she works 4 days/week at the corp and 2 days/week at her own office, which is managed by her husband, who is also a dentist. Most managing GPs are required to work full time by the Corp but she is too good and fast that they have to make an exception for her. I don't know how much she makes but I always see her driving a new Mercedes every 2-3 years.

Also another point I would like to make is that as an owner GP, your growth potential is limitless. A good business mind can probably grow a practice very large, expand to multiple locations etc. Whereas working at a corp your ceiling is limited, limited to the amount you can produce. As an owner, you can reach the point where everything runs smoothly without you and you can be even be an absentee owner, possibly when you are reaching the point of retirement. No chance of doing that as an employee at a corp.

Agree completely. The sky's the limit when you have your own office. The problem is not everybody has the right skills to run a successful practice. Being a specialist at a corp, I have the opportunities to meet a lot of GPs. Some of them had their own offices before but they didn't do very well ....and they had to sell their practices and come to work for the corp.

 

[2TH MVR]

. As an owner, you can reach the point where everything runs smoothly without you and you can be even be an absentee owner, possibly when you are reaching the point of retirement.

ok. There's also the other possibility. As you get older ... You fail to keep your practice RELEVANT for the times. The younger docs are opening all around you. Corps are also encroaching your area. I've seen this where older docs were resistant to change and simply ran their practices into the ground. Practices worth nothing.
Goes both ways.

 

[charlestweed]

ok. There's also the other possibility. As you get older ... You fail to keep your practice RELEVANT for the times. The younger docs are opening all around you. Corps are also encroaching your area. I've seen this where older docs were resistant to change and simply ran their practices into the ground. Practices worth nothing.
Goes both ways.

You have to constantly work hard to bring in the new patients in order to maintain the same level of success. Neither your associate dentists nor your office staff care about your practice the way you do becausse it's not their practice. They only want to do the minimally required tasks you assign them. And when you are not physically present at the office, they will be on the phone/computer surfing the net. The reason many older dental practices are declining is the owners stop trying because they are getting tired, they no longer have debts, and they already save enough for their retirements. I think by the time I retire, all my practices will probably worth nothing...I will just close up shop and leave...and that's why I only lease (instead of purchasing) the office building.

 

[753698]

Hey. Welcome to the club. I'm half Asian. Seriously.... You shouldn't worry about that issue.

You are correct that eventually the Corps will start opening in rural areas, but not to the extent of a saturated, urban city.

Also.... in a rural setting ... You will be better able to DIFFERENTIATE your private practice from the Corps. More community involvement. Marketing to show how your private practice is more service and patient oriented as compared to the for profit Corps. You can do this!

Yeah I see what you mean. But in terms of quality of life for myself, I don't see myself being comfortable living there anyways. I've never lived in a rural area before, and now that I am in a rural area for college, I can say that I do not really enjoy it that much. It honestly gives me depressing vibes for some reason. Maybe I could travel to work, but that would ruin the sense of "community" right?

ok. There's also the other possibility. As you get older ... You fail to keep your practice RELEVANT for the times. The younger docs are opening all around you. Corps are also encroaching your area. I've seen this where older docs were resistant to change and simply ran their practices into the ground. Practices worth nothing.
Goes both ways.

I suppose the dentist is SOL in this scenario haha. I bet it does happen a lot, I see a lot of practices listed for sale where it seems like the owner just let it slip. But even if this dentist does join corporate, he will probably now not have the stress of managing a practice but rather the stress of producing high numbers so the corp is happy with the $ they can accumulate, otherwise this dentist will end up like the other dentists that get fired for not being productive enough.

It's a lose lose scenario really.

 

[753698]

There is also a surplus of orthodontists as well, especially here in CA. Just do a quick search on this forum and you will see a of posts about new grad orthodontists who couldn't find work after they finished their ortho residency. Specialists and GPs are equally easily replaceable if they can't produce, can't handle busy schedule, have poor clinical skills, and get too complaints from patients. I had worked for 3 different corps (Western Dental, SmileCare, Brightnow) in the past. And the reason for these corps to hire me was to replace the previous orthodontists who under-performed.

The managing GP, who works at the same corp with me, has worked here for 10+ years. Every year, the corp gives her an award for being the top producing GP in the region. Because she is good, the manager usually saves all difficult and high production cases for her to perform and assign easier cases for other GPs in the corp to perform. Currently, she works 4 days/week at the corp and 2 days/week at her own office, which is managed by her husband, who is also a dentist. Most managing GPs are required to work full time by the Corp but she is too good and fast that they have to make an exception for her. I don't know how much she makes but I always see her driving a new Mercedes every 2-3 years.


Agree completely. The sky's the limit when you have your own office. The problem is not everybody has the right skills to run a successful practice. Being a specialist at a corp, I have the opportunities to meet a lot of GPs. Some of them had their own offices before but they didn't do very well ....and they had to sell their practices and come to work for the corp.

Imagine how much that managing GP produces though, and how hard she works if she is really awarded as the top producing GP in the region. If she dedicated all that hard work and time to her own practice, don't you think she would earn significantly more, and also have a lot more autonomy etc. Her potential in private practice is probably a lot higher than it is as an employee at corp. She might drive a new Mercedes every week if she spent 6 days/week at her own practice 😀

And as you said, not every dentist has good business skills, but at the same time not ever dentist has the clinical skills as that managing GP. And I would argue it is a lot easier to gain business acumen than it is to gain dexterity, which is mostly genetically determined.

Private practice allows a dentist to work at a speed they are comfortable with, because not everyone can blaze through patients like that managing GP. Work slow at a corps and you're fired.

 

[753698]

Also another thing to note is from my shadowing experience at a rather large private practice, I have seen the type of relationship that my dentist has with all his patients. He has literally seen them for 30+ years (and has seen me grow from a tiny kid to an adult ready to become a dentist myself). This is a very large practice with thousands of patients so it's safe to say he's made a huge impact on many lives for decades. His patients know him very well and vice versa. That has to bring a lot of fulfillment to anyone. It's a dentist's dream, is it not?

Compare that to corps, and it seems you never get to foster those types of relationships. It's mostly a revolving door of patients. If a dentist were to retire working corps, not many people would probably even notice. However, if an established private practitioner who has fostered close relationships for decades retired it would cause a dental earthquake.

 

[charlestweed]

Imagine how much that managing GP produces though, and how hard she works if she is really awarded as the top producing GP in the region. If she dedicated all that hard work and time to her own practice, don't you think she would earn significantly more, and also have a lot more autonomy etc. Her potential in private practice is probably a lot higher than it is as an employee at corp. She might drive a new Mercedes every week if she spent 6 days/week at her own practice 😀

And as you said, not every dentist has good business skills, but at the same time not ever dentist has the clinical skills as that managing GP. And I would argue it is a lot easier to gain business acumen than it is to gain dexterity, which is mostly genetically determined.

Private practice allows a dentist to work at a speed they are comfortable with, because not everyone can blaze through patients like that managing GP. Work slow at a corps and you're fired.

I am sure if this managing GP knows how to do what you said on your above post, she would do it a long time ago and not has to work for the corp. The hardest part of owning a practice is to know how attract the new patients to come to your office and to convince them to accept your recommended tx. The patients have to have $$$ to pay for your recommended tx plan. Your office has to accept their insurance plans....some offices don't accept HMO, medicaid. Working hard, being good clinically and fast with your hands are not good enough because there is a limited supply of patients due to oversaturation of dentists, economic recession, unemployement that cause many patients to lose their dental insurance etc. At least working for the corp, this managing GP doesn't have to worry about bringing in the new patients....she just needs to treat the patients 9am-6pm and then goes home with her 3 kids. She currently owns 2 practices and the practices don't have enough patients to keep 2 dentists (herself and her husband) busy.

....And working 2 days/week at her own offices doesn't mean that her offices are suffering. Maybe she is too fast that she only needs to work 2 days/week there...and she wants to double her income by working for the corp office. BTW, she also owns the office building, a Victorian style house, which she converted into a dental office.

 

[753698]

I am sure if this managing GP knows how to do what you said on your above post, she would do it a long time ago and not has to work for the corp. The hardest part of owning a practice is to know how attract the new patients to come to your office and to convince them to accept your recommended tx. The patients have to have $$$ to pay for your recommended tx plan. Your office has to accept their insurance plans....some offices don't accept HMO, medicaid. Working hard, being good clinically and fast with your hands are not good enough because there is a limited supply of patients due to oversaturation of dentists, economic recession, unemployement that cause many patients to lose their dental insurance etc. At least working for the corp, this managing GP doesn't have to worry about bringing in the new patients....she just needs to treat the patients 9am-6pm and then goes home with her 3 kids. She currently owns 2 practices and the practices don't have enough patients to support 2 dentists (herself and her husband).

I completely understand. But rather than working so hard at the corporate practice, why doesn't she learn some marketing tactics. She's obviously a very good clinician, but if she builds up on the business side of things she should be able to attract patients. Maybe she should start by accepting more insurance plans in her offices.

I'm not sure how old she is, but working 9-6 for 4 days while treating so many patients to make her THE top producer...will that not lead to severe burnout, when you also add in the 2 days at her own office? Not to mention she also does the high production cases, which I'm assuming are endo, implants, crowns etc. These are generally tougher than regular fill and drill right? I can see why corp would never replace her, she is a money making machine for them. I feel like the guys up top benefit more than she does in this scenario.

 

[charlestweed]

I completely understand. But rather than working so hard at the corporate practice, why doesn't she learn some marketing tactics. She's obviously a very good clinician, but if she builds up on the business side of things she should be able to attract patients. Maybe she should start by accepting more insurance plans in her offices.

Like I said before, if she knew how to improve her business skills to get a lot of patients in to keep both of her private practices busy 5-6 days/week, she would have done this a long time ago.

I'm not sure how old she is, but working 9-6 for 4 days while treating so many patients to make her THE top producer...will that not lead to severe burnout, when you also add in the 2 days at her own office? Not to mention she also does the high production cases, which I'm assuming are endo, implants, crowns etc. These are generally tougher than regular fill and drill right? I can see why corp would never replace her, she is a money making machine for them. I feel like the guys up top benefit more than she does in this scenario.

She is in her mid 40s and has practiced general dentistry for 20+ years. It's actually easier to make money (and easier on your hands and back as well) doing endo, implant, and crown cases than doing drills and fills. It takes a good clinician less than 1/2 hour to place 1 implant and gets paid $1000-2000. It takes 15-20 minutes to do one filling and only gets paid around $100-150...and if the office accepts HMO, the dentist gets paid $0 for doing that filling. And that's why a lot of GP practices don't accept HMO and medicaid.

 

[2TH MVR]

Exactly as CharlesTweed said. There aren't long lines of patients

Like I said before, if she knew how to improve her business skills to get a lot of patients in to keep both of her private practices busy 5-6 days/week, she would have done this a long time ago.

It's all about the supply of new patients. Practice in an area with plenty of new patients .... then your practice aspirations can be the sky. No amount of business acumen is going to make up for a poor location with a depleting supply of new patients. Sure ... there are always exceptions. For an ortho ..... I would always look for new subdivisions and all those rooftops. Young families. This formula worked great for many years but as time went on .... as you would expect ..... OTHERS (orthos, Corps, group practices) would also gravitate to these new, emerging areas .....until ......the pie pieces (supply of new patients) just gets smaller and smaller.

GPs have it a little better. Their active patient list will always require active and recall treatment. Not so for an ortho, OMFS, endo, perio.

Mr. Shak. To think big is great. But you need that supply of new patients to fuel your business plans.

The old adage: "Treat patients well and the rest will take care of itself". Yes .... this is mostly true, but I have found through experience that even treating patients well will not make up for a poor location that became saturated.

 

[753698]

Like I said before, if she knew how to improve her business skills to get a lot of patients in to keep both of her private practices busy 5-6 days/week, she would have done this a long time ago.

She is in her mid 40s and has practiced general dentistry for 20+ years. It's actually easier to make money (and easier on your hands and back as well) doing endo, implant, and crown cases than doing drills and fills. It takes a good clinician less than 1/2 hour to place 1 implant and gets paid $1000-2000. It takes 15-20 minutes to do one filling and only gets paid around $100-150...and if the office accepts HMO, the dentist gets paid $0 for doing that filling. And that's why a lot of GP practices don't accept HMO and medicaid.

Oh wow now I know why specialists make so much compared to GP's. It's probably because they don't have to spend time doing drill and fill haha.

Just out of curiosity, how are there GP's that make really high amounts if a lot of their time will be devoted to doing low profit fillings? Or do they just do high profit procedures and leave fillings to an associate?

Also, can a GP essentially make himself a specialist without the official title if he chooses to do a lot of endo, implants, maybe even braces to increase his own income? I assume he would have to take a ton of CE courses, and maybe his overhead will be higher since he will need a variety of equipment to do the various procedures. How would this work out? And what will he do about fillings?

 

[753698]

Exactly as CharlesTweed said. There aren't long lines of patients


It's all about the supply of new patients. Practice in an area with plenty of new patients .... then your practice aspirations can be the sky. No amount of business acumen is going to make up for a poor location with a depleting supply of new patients. Sure ... there are always exceptions. For an ortho ..... I would always look for new subdivisions and all those rooftops. Young families. This formula worked great for many years but as time went on .... as you would expect ..... OTHERS (orthos, Corps, group practices) would also gravitate to these new, emerging areas .....until ......the pie pieces (supply of new patients) just gets smaller and smaller.

GPs have it a little better. Their active patient list will always require active and recall treatment. Not so for an ortho, OMFS, endo, perio.

Mr. Shak. To think big is great. But you need that supply of new patients to fuel your business plans.

The old adage: "Treat patients well and the rest will take care of itself". Yes .... this is mostly true, but I have found through experience that even treating patients well will not make up for a poor location that became saturated.

Do you think that oversaturation could be brought down if the ADA intervenes and stops letting so many dentists graduate every year + the high amount of foreign trained dentists entering the country as well?
If crazy amounts of dentists keep entering the workforce it won't matter rural or urban, corporate or no corporate, the profession will start breaking down right?

I'm wondering if I'm entering dentistry at the absolute worst time possible. Dental income is decreasing while everything is getting more expensive (inflation) and this too while the economy is relatively good.

I know the grass is always greener on the other side, but from what I know Medicine is backed by the government, and while that can be a bad thing too, atleast they have the guarantee that their incomes will keep up with inflation. Dentists OTOH are relatively independent and there is no guarantee for the future of the profession.

@charlestweed I read some of your earlier posts about how you were considering medicine before dentistry. Obviously being an ortho probably worked out really well for you, but if you had to say now what the better path would be without any bias looking into the future what would you say? There's a physician shortage so oversaturation doesn't seem do be a problem except in major metro areas. Otherwise they seem to have similar issues to dentists (insurance, midlevels, corporations taking over etc.)

 

[charlestweed]

Oh wow now I know why specialists make so much compared to GP's. It's probably because they don't have to spend time doing drill and fill haha.

Just out of curiosity, how are there GP's that make really high amounts if a lot of their time will be devoted to doing low profit fillings? Or do they just do high profit procedures and leave fillings to an associate?

Also, can a GP essentially make himself a specialist without the official title if he chooses to do a lot of endo, implants, maybe even braces to increase his own income? I assume he would have to take a ton of CE courses, and maybe his overhead will be higher since he will need a variety of equipment to do the various procedures. How would this work out? And what will he do about fillings?

Specialists get paid more for each procedure they perform and for the amount of time that they spend on each patient. The problem is the specialists don’t have as many patients as the GPs have. GPs usually keep most of the cases to themselves and only refer a few difficult ones to the specialists. The specialist’s success depends on how well he/she communicates with the referring GPs. A periodontist who only has 2-3 implant cases a day (because there are only a few GP offices that refer patients to him) may make less than a GP, who does 1-2 endo cases + 3-4 fillings + 3-4 cleanings + 2-3 extractions + 1 crown prep in a day. The GP, in this example, has to work a lot harder and much longer hour than the periodontist but because of the higher patient volume this GP sees, he ends up making more than the periodontist. For the specialists to get more patients and to make more than the GPs, they may have to travel to multiple offices. I have to travel to 6 different offices.

 

[charlestweed]

@charlestweed I read some of your earlier posts about how you were considering medicine before dentistry. Obviously being an ortho probably worked out really well for you, but if you had to say now what the better path would be without any bias looking into the future what would you say? There's a physician shortage so oversaturation doesn't seem do be a problem except in major metro areas. Otherwise they seem to have similar issues to dentists (insurance, midlevels, corporations taking over etc.)

It depends. To do well as a dentist, you have to own your own office….and the sky’s the limit. You have to have good people skill. You have to take the risk to open a practice. In dentistry, you have to “sell” cases. If your plan is to work for the corp or for another dentist owner for the rest of your life…and only make $120-200k, then I think medicine is a better route because most physicians who work at the hospitals make more and have better benefits (401k, paid vacations etc).

Working as a general dentist is very hard…both physically (back pain is a very common problem) and mentally. IMO, the only good dental specialty that is worth pursuing is ortho but it’s extremely hard to get into ortho…being good in all science classes is not good enough, you also have to have good hand skill in order to get good grades in all your pre-clinical classes. In medicine, you have more options….there are more specialties and subspecialties in medicine…..and the only thing you need to do well on is the USMLE step 1.

 

[roadtodmd1]

I work for a corporate dental office right now as a dental assistant. I absolutely hate it. I want to quit so bad

Sent from my ONEPLUS A6013 using SDN mobile

 

[Medin2017]

Isn't corporate the best place to get faster? I heard sometimes you can be mentored there too. Correct me if I'm wrong experienced dentists, but isn't it a good plan to work 50+ hours at a corporate your first year or two out and really get your feet wet while taking CE courses? There are stories of private practice docs screwing over assistants or doing unethical things too, so I don't think there's a right or wrong here.

 

[2TH MVR]

Isn't corporate the best place to get faster? I heard sometimes you can be mentored there too. Correct me if I'm wrong experienced dentists, but isn't it a good plan to work 50+ hours at a corporate your first year or two out and really get your feet wet while taking CE courses? There are stories of private practice docs screwing over assistants or doing unethical things too, so I don't think there's a right or wrong here.

It's just a job. I would NEVER go into dentistry to work Corp the rest of my life. I would use Corp to augment a private practice. Will you get faster? Sure, but at what costs? The veterans doctors at Corp are fast, but we've been doing this for a long time. We're good at it. A new dentist out of DS? Fast most likely will equate with poor work. Don't be fooled into thinking no one at Corp will know about poor work. Just the last 2-4 months at the Corp I work at .... 1 ortho and 1 dentist were fired. I know another ortho who is on the hot seat.

Pros of Corp. Comradery with other GPs and Specialists. Patients have instant access to all the specialties. I have to admit that when I was in private practice .... you feel somewhat alone. Just you, the staff and patients. In Corp .... there must be 30-40 employees and 3-4 dentists working together. I enjoy going out to lunch with the dentists and specialists. The other pro is benefits. I cannot stress this enough. I pay around $300 per month for medical/vision,etc for a family of 4. My deductible is $1000. In private practice (PP) ... I paid $1600 per month with a LARGE deductible. There is also a 401K, but the employer does not match my contributions. Obviously the biggie is that you only haveto concentrate on patient care. Running a dental practice is not simple. The stress of constantly dealing with problems can wear you down.

Cons of Corp? Well ... it's a Corp. You come in and have to fix all the crap done prior to your arrival. Again ... pt's didn't come there to see YOU. It's sort of an empty feeling working at a Corp. No equity in your efforts. Just money.

Me? I would work in a busy GP office for 12 months. LEARN everything you can about the business of dentistry. Then open or buy an in expensive practice. Keep your associate job or Corp job PT.

 

[753698]

It depends. To do well as a dentist, you have to own your own office….and the sky’s the limit. You have to have good people skill. You have to take the risk to open a practice. In dentistry, you have to “sell” cases. If your plan is to work for the corp or for another dentist owner for the rest of your life…and only make $120-200k, then I think medicine is a better route because most physicians who work at the hospitals make more and have better benefits (401k, paid vacations etc).

Working as a general dentist is very hard…both physically (back pain is a very common problem) and mentally. IMO, the only good dental specialty that is worth pursuing is ortho but it’s extremely hard to get into ortho…being good in all science classes is not good enough, you also have to have good hand skill in order to get good grades in all your pre-clinical classes. In medicine, you have more options….there are more specialties and subspecialties in medicine…..and the only thing you need to do well on is the USMLE step 1.

Oh yeah I definitely want to be an owner, that's why I liked dentistry in the first place. It gives a lot of entrepreneurial opportunities in healthcare. It's also why I don't really like corp because I feel they will be the main competition against my aspirations for my career.

It's interesting that you said ortho is the only specialty that's worth it though, because mostly from what I read ortho is the worst specialty to get into for the future, for things like commoditization of orthodontics with things like invisalign, more GP's doing orthodontics etc. Ortho was arguable the best specialty in the past but for the future aren't specialties like OMFS or Endo more safe? With even Endo possible taking a hit as more GP's do root canals, and OMFS possibly taking a hit with other specialties making inroads towards some of the procedures OMS do like extractions/implant placements.

 

[charlestweed]

Oh yeah I definitely want to be an owner, that's why I liked dentistry in the first place. It gives a lot of entrepreneurial opportunities in healthcare. It's also why I don't really like corp because I feel they will be the main competition against my aspirations for my career.

I don't think corporations are the main competitors of private dental practices but other private offices are. Private practice dentists are competing against each other for patients. A new private office that is set up next to yours would be a bigger threat than a new corp office. Corp and private offices attract 2 different kinds of patients:

-Corp offices: medicaid, cheap HMO plans, low income earners, and other patients that private practices don't want to treat.

-Private offices: Fee for service, PPO plans, middle to high income population.

It's interesting that you said ortho is the only specialty that's worth it though, because mostly from what I read ortho is the worst specialty to get into for the future, for things like commoditization of orthodontics with things like invisalign, more GP's doing orthodontics etc. Ortho was arguable the best specialty in the past but for the future aren't specialties like OMFS or Endo more safe? With even Endo possible taking a hit as more GP's do root canals, and OMFS possibly taking a hit with other specialties making inroads towards some of the procedures OMS do like extractions/implant placements.

Each specialty has its own problem. Both ortho and pedo face oversaturation problem due to openings of new residency programs. OMFS and perio compete against each other for patients. Most GPs do their own endos. Like I said before, your success as a specialist depends on how well you communicate with the referring GPs..... and most important of all, how hard you work.

Ortho is the best because it's an easy job (easy on your hands, back, and mind) that allows you to see very high volume of patients (50-100 patients) in 1 day and not feeling exhausted at the end of the day like the general dentists and other specialists. And if you are not picky, are willing to accept any job offer, travel to multiple offices, and works 5-6 days/week etc, you can see up to 1000-1500 patients in a month. Because the job is less physically demanding, many orthodontists can work well into their late 60s-70s...while their GP friends have to retire. Higher patient volume + more years of working = more $$$.

Unlike other specialties that rely 100% on GPs for referrals, orthodontists can market their practices directly to the public...and they bypass the insurance companies by offering their own in-house payment plans directly to their patients

 

[Medin2017]

It's just a job. I would NEVER go into dentistry to work Corp the rest of my life. I would use Corp to augment a private practice. Will you get faster? Sure, but at what costs? The veterans doctors at Corp are fast, but we've been doing this for a long time. We're good at it. A new dentist out of DS? Fast most likely will equate with poor work. Don't be fooled into thinking no one at Corp will know about poor work. Just the last 2-4 months at the Corp I work at .... 1 ortho and 1 dentist were fired. I know another ortho who is on the hot seat.

Pros of Corp. Comradery with other GPs and Specialists. Patients have instant access to all the specialties. I have to admit that when I was in private practice .... you feel somewhat alone. Just you, the staff and patients. In Corp .... there must be 30-40 employees and 3-4 dentists working together. I enjoy going out to lunch with the dentists and specialists. The other pro is benefits. I cannot stress this enough. I pay around $300 per month for medical/vision,etc for a family of 4. My deductible is $1000. In private practice (PP) ... I paid $1600 per month with a LARGE deductible. There is also a 401K, but the employer does not match my contributions. Obviously the biggie is that you only haveto concentrate on patient care. Running a dental practice is not simple. The stress of constantly dealing with problems can wear you down.

Cons of Corp? Well ... it's a Corp. You come in and have to fix all the crap done prior to your arrival. Again ... pt's didn't come there to see YOU. It's sort of an empty feeling working at a Corp. No equity in your efforts. Just money.

Me? I would work in a busy GP office for 12 months. LEARN everything you can about the business of dentistry. Then open or buy an in expensive practice. Keep your associate job or Corp job PT.

Cool didn't think of some of this before. Seems like no where is as good as the old days in any industry, so can't complain about any trends.

 

[ysrebob]

As a solo GP I can think of a several plausible reasons why I may not be able to make a whole career as the owner of a small traditional FFS practice the way our predecessors did… but corporate dentistry is NOT one of them. In the current environment a well-run private practice can compete head to head against corps.

- sure they have much better access to capital, but all that does is make it easy for them to rapidly open more offices; it doesn't do anything for the efficiency of any given office.
- sure they have lower supply and lab costs. That gives them maybe a 5% overhead edge, at best, on somebody like me.
- they also have layers of upper management plus investors that need to be paid... costs them a lot more than 5% overhead vs me

The only thing corp pressure could force private practices to do would be to expand to a more efficient scale vs the traditional 4-day-a-week solo office: i.e. scale up to 2-3 dentists, split schedules, open extended hours 6 days. Operating at this scale I think a lean, well-run private practice can achieve a lower cost structure than is even possible for corp.

 

[753698]

As a solo GP I can think of a several plausible reasons why I may not be able to make a whole career as the owner of a small traditional FFS practice the way our predecessors did… but corporate dentistry is NOT one of them. In the current environment a well-run private practice can compete head to head against corps.

- sure they have much better access to capital, but all that does is make it easy for them to rapidly open more offices; it doesn't do anything for the efficiency of any given office.
- sure they have lower supply and lab costs. That gives them maybe a 5% overhead edge, at best, on somebody like me.
- they also have layers of upper management plus investors that need to be paid... costs them a lot more than 5% overhead vs me

The only thing corp pressure could force private practices to do would be to expand to a more efficient scale vs the traditional 4-day-a-week solo office: i.e. scale up to 2-3 dentists, split schedules, open extended hours 6 days. Operating at this scale I think a lean, well-run private practice can achieve a lower cost structure than is even possible for corp.

So essentially operate like a medical group practice does with multiple physicians? I think that's how physicians adapted to corporate taking over medicine, competing with hospital services. I think it's a smart idea but you have to be able to find dentists who want to work the weekends, and who want to work the evening shifts etc. Many dentists are too comfortable with their 9-5 4 day a week lifestyle.

 

[2TH MVR]

I've noticed that the large Corp I work for has, over the years, implemented their OWN lending system. This isn't new, but this used to be 100% outsourced (i,e Carecredit, et al) by most private practices and Corps or given away for free by most PP orthos (free money for 18-24 months .... 0% interest 24 mos loans, etc. etc.). The Corp is acting like a bank and collecting the lending fees. So a typical fee for 24 months of ortho tx or 2-3 implants is relatively high if the patient agrees to the Corp interest rates. If the Corp or private office outsources this (Carecredit, etc.) you lose a certain % of your fee. The Corps are getting it all. The tx fee and the lending fees.

As a result our fees plus the lending interest is =/> than most other PP fees and/or Corp fees. This also equates to less starts, but apparently this is the direction my Corp is taking. Apparently other large Corps are taking notice of this self lending practice and are also looking at it.

Again .... not saying the concept is new .... but the Corps are finding money in the actual process of lending where PP are too small to act as lenders. Remember GMAC financing for automaker GM? I remember reading that the financing arm of GM actually made more $$$$ than the selling of the cars and trucks. All of the big car manufacturers want you to use THEIR in house lending. Now the dental Corps are doing the same thing.

 

[deleted547631]

Two very successful solo GP offices that I shadowed at when I was a predental student back in the day just sold to corporate entities, both within the last six months. If I was a predental student in this day and age I’d strongly consider doing something else.