Corporate vs private specialist jobs

[aaaaa]

Some thoughts.

1. For years .... the accepted route out of school was to enter a partnership or associateship leading to eventual ownership. That was my entry into ortho ownership. Associate for 6 months ..... partnership for 18 months ..... owner. Of course .... all of this was in writing from day one of the partnership (buyout in 18 months). Lots of positives. Mentorship. Real life learning. Salary. Probably most important was that the new dentist/specialist was buying in a situation where the older docs have done all the work to establish a successful practice. Pretty sure most young grads (specialists) have no idea how hard it is to finance/build a practice and then establish referrals. It is very difficult being the young guy trying to break into established referral patterns. It's give and take. As the OP stated .... the older docs are not as aggressive as they once were. That's why YOU ARE there. A young specialist can establish new referrals with the younger dentists. Also .... the older docs have a built-in situation for when they want to retire. Right or wrong.

or 2. Quote. "You're getting screwed over." End quote.

Then 3. This is a good example of the reality of Corp dentistry. Corp dentistry offering higher levels of $$$$ than established speciality practice with multiple partners. The reality of Corp dentistry taking over.

I think the $$$ may be better for specialists in corporate currently but for how long? Eventually corporate offices will start cutting specialist pay just like they did/do for general dentists. That’s the problem with corporations/private equity being involved in anything healthcare related. It’s all about profit. Eventually when they’ve saturated all areas and gotten supply costs as low as possible where do you think they’ll start squeezing costs??? It’ll be the ortho/oms/perio/endodontists.

---

Members don't see this ad.

 

[ToothJockey]

I think the $$$ may be better for specialists in corporate currently but for how long? Eventually corporate offices will start cutting specialist pay just like they did/do for general dentists. That’s the problem with corporations/private equity being involved in anything healthcare related. It’s all about profit. Eventually when they’ve saturated all areas and gotten supply costs as low as possible where do you think they’ll start squeezing costs??? It’ll be the ortho/oms/perio/endodontists.

I've always wondered, what stops corps from paying specialists 25% collections like they pay their GP's?
I've heard associates used to get paid 35% way back in the 90s, so pay has already been cut by 10%. What's stopping corps from cutting pay to 15% collections in the future, especially if they have a monopoly on the entire industry?

 

[charlestweed]

I've always wondered, what stops corps from paying specialists 25% collections like they pay their GP's?
I've heard associates used to get paid 35% way back in the 90s, so pay has already been cut by 10%. What's stopping corps from cutting pay to 15% collections in the future, especially if they have a monopoly on the entire industry?

If corps pay the specialists too little, then they will have problems finding the specialists to work for them….then the specialists will start looking for jobs at private specialty practices or work at GP practices as in-house specialists. The reason why many specialists prefer working for corp offices is corp offices pay them higher salaries than private practices.

Back in the 90s, corps paid the dentists much worse than right now….only $200-300 a day. Back in the 90s, the associate dentists only made $60-70k a year. When my sister graduated in 2000, she worked for SmileCare, which was later bought by Coast Dental in 2008, and they paid her $350 a day. Three years later, when she started her own office, she worked P/T at my corp office and they paid her $550 a day. She quit this P/T job in 2007 because her own office got busier. Now, according my GP friends who hire associate dentists, the average pay for general dentists at most private practices is $600/day. My corp stopped paying their GPs a fixed per diem rate since the recession in 2008….I think they currently pay the GPs 23% of the production. My corp still pays me a fixed daily rate + a bonus of $75 per new start. My corp pays the periodontists $800 a day or 40% of the production, whatever is higher.

 

[ToothJockey]

If corps pay the specialists too little, then they will have problems finding the specialists to work for them….then the specialists will start looking for jobs at private specialty practices or work at GP practices as in-house specialists. The reason why many specialists prefer working for corp offices is corp offices pay them higher salaries than private practices.

Back in the 90s, corps paid the dentists much worse than right now….only $200-300 a day. Back in the 90s, the associate dentists only made $60-70k a year. When my sister graduated in 2000, she worked for SmileCare, which was later bought by Coast Dental in 2008, and they paid her $350 a day. Three years later, when she started her own office, she worked P/T at my corp office and they paid her $550 a day. She quit this P/T job in 2007 because her own office got busier. Now, according my GP friends who hire associate dentists, the average pay for general dentists at most private practices is $600/day. My corp stopped paying their GPs a fixed per diem rate since the recession in 2008….I think they currently pay the GPs 23% of the production. My corp still pays me a fixed daily rate + a bonus of $75 per new start. My corp pays the periodontists $800 a day or 40% of the production, whatever is higher.

I see what you mean, but to be fair $200-300 back in the 90s is probably about the same or better than ~$500 today, due to inflation. Everything was cheaper back then.

Do you remember what percentage they paid associates back then? If it was 35% back then, then it means associates today are working harder for less money, adjusted for inflation of course. 23% today is already pretty low imo. If corporate employs majority of dentists in the future then they can choose what to pay the dentists, and they will always choose to pay dentists less and less money so they can make higher profits themselves.

 

[OSOSOS]

OS don't stay in corporate worlds because it's REALLY HARD WORK and most have private offices that provide a great income. Maybe it's half or 1/4 of corporate pay but corporate isn't a long term viable solution for most mentally and physically. It is hard work. Residency level hard work at times. I will be honest, if you ONLY do corporate though, the whole beast becomes much more managable. Too many are moonlighting corporate while building a private office. Gets overwhelming. Burnout......

Corporate OS pay is usually 25-45% depending on who is providing staff, drugs, permits, collections vs production vs adjustments included, financing charges, etc. There is a floor to this because again, it's really hard work. Can't compare it to GP pay either. The more revenue you bring in, the higher your percent can go as the fixed expenses are already paid. A GP collecting $2k vs an OS collecting $15k for the day.....the OS compensation has way more wiggle room and still have profits for all. An OS making $2k a day will not get 40% long term, just doesn't work out for the corporates (it also doesn't work well for your private office unless you have minimal part time employees).

Specialists working in traditional GP offices tend to not have as productive days but they also tend to have pretty chill days. Less staff overhead. Less hustle. In my community is higher fees also as the GPs that are fee for service bring in the specialists out of network and again, full fee. It's a growing opportunity for both GPs and specialists. Again, a huge hit to the traditional referral model.

I agree young specialists don't understand how hard it really is to break into a market, myself included. However, many of these specialist offices are so overblown with overhead and lack of change that they become a burden to young specialists. Add on lack of mentorship and senior docs being checked out, I am SHOCKED that corporates don't have a line of specialists waiting to get a piece of it. I think we are all so engrained in the traditional pathway for practice. I don't think a retiring specialist should be paid a ton of money for buy out. Tons of money for buy out, and a chill schedule, and not bringing in the bucks??

 

[2TH MVR]

I've always wondered, what stops corps from paying specialists 25% collections like they pay their GP's?

I can only comment on orthodontists at my Corp. Like @charlestweed .... I receive a daily minimum and PER START BONUS along with other smaller bonuses (product sales, type of braces selected by pt, etc.). Doesn't matter if I see one patient or 60 patients that day ... I receive the same per diem minimum. At my point in my life .... that minimum is everything. Production for an orthodontist is STARTS. Think about this. It is the responsibility of the Corp to SUPPLY these new patients in order for me to START THEM. If the Corp was slow and there were no new pt exams ... therefore no starts .... therefore less production .... why would I continue to work there?

This is another reason why I sleep well at night re: ortho production at Corps. Pts either want braces, aligners or not. The product (straight teeth) sells itself. Pricing or financing options obviously plays a large role. But STARTS are everything. Same in private practice.

 

[ibuprofen400mg]

Dont ever work for an office paying less than 45 percent of production.

 

[Cold Front]

Great real world feed back on OS and general dentistry in corporate world. Any lurkers care to comment on Endo? Pedo? Perio? Corporations needs them too.


Sent from my iPhone using Tapatalk

 

[charlestweed]

I see what you mean, but to be fair $200-300 back in the 90s is probably about the same or better than ~$500 today, due to inflation. Everything was cheaper back then.

Do you remember what percentage they paid associates back then? If it was 35% back then, then it means associates today are working harder for less money, adjusted for inflation of course. 23% today is already pretty low imo. If corporate employs majority of dentists in the future then they can choose what to pay the dentists, and they will always choose to pay dentists less and less money so they can make higher profits themselves.

Not just at the corp offices. This applies to private practice owners, who hire associate dentists, as well. Dentistry is a business and like any other businesses, the dentist owners want to make as much profit as possible and pay their associate as little as possible. This is not being greedy. You will understand when you become an owner and have to pay bills (student loans, associate salaries, staff salaries, supplies, rents etc). I used to criticize my employers for being greedy. Now that I am an owner, I change my thinking.

It's supply and demand. If the owners/corp offices have no problem finding associate dentists, who are willing to get paid X dollars per day, there is no reason for these employers to pay their associate dentists more.....unless the associate dentists really care about their boss' practices and the patients really love them. The problem is most associates don't care....they just want to do the minimum and dump difficult cases to the specialists or back to the owner dentists so they can go home on time and sleep better at night. I am a corp's employee and I admit that I am also guilty of not caring for the success of the company that I work for.

 

[charlestweed]

Dont ever work for an office paying less than 45 percent of production.

If this job is the only job that you can find in the area, if you have high student loan debt to pay, if you have have kids to support, if and if you have your own office and still have to pay back the practice loan, then I think you should take the job even though it pays much less than 45%. It's better to make some money than staying home doing nothing. It's better to make some money and lease a cool BMW or a 911 than having to drive a Honda.

If there are plenty of good paying jobs that are available in your area, then of course, you would take the job that pays the most first.

 

[Deep Impact]

Good stuff...as I read more and more of these posts, I am getting more convinced that I’ve been completed duped and blinded by this partnership allure, especially my situation. Seriously, what the hell was I thinking.

I consider myself to be an excellent clinician and was told by many my clinical efficiency would translate well in private practice. My limiting factor right now is lack of efficiency at my current practice. Our overhead is atrocious with old employees who can’t even stay standing, rude etc but are staying employed while we provide full benefit. I sit and browse a lot and have time for SDN. Everyday, all day. Bought too much stuff on amazon browsing and thinking about an escape plan if any reasonable ones exist.

Don’t know man...I feel like I’m wasting my youth and losing out by staying here at my partnership. Should’ve hustled at a DSO like my buddies and started my own practice in retrospect. Clock is ticking, I’m getting older and soon I may just succumb to the status quo.


Sent from my iPhone using Tapatalk

 

[OSOSOS]

Good stuff...as I read more and more of these posts, I am getting more convinced that I’ve been completed duped and blinded by this partnership allure, especially my situation. Seriously, what the hell was I thinking.

I consider myself to be an excellent clinician and was told by many my clinical efficiency would translate well in private practice. My limiting factor right now is lack of efficiency at my current practice. Our overhead is atrocious with old employees who can’t even stay standing, rude etc but are staying employed while we provide full benefit. I sit and browse a lot and have time for SDN. Everyday, all day. Bought too much stuff on amazon browsing and thinking about an escape plan if any reasonable ones exist.

Don’t know man...I feel like I’m wasting my youth and losing out by staying here at my partnership. Should’ve hustled at a DSO like my buddies and started my own practice in retrospect. Clock is ticking, I’m getting older and soon I may just succumb to the status quo.


Sent from my iPhone using Tapatalk

I feel like you are writing about my life just 2 years ago. Old wounds.

No rash decisions. Just try it out and see what supports your life, goals, mental and physical health the best. Financially you’ll be fine either way. What do you want your daily battle to be. Corporate and private have their own unique battles. One of them might weigh you down, the other might give you your fight back.

 

[aaaaa]

What will the specialist private practice model look like in the future. With how many specialists work for corporate or out of gen dentists offices is it even worth it low days to build a traditional practice as a specialist?

 

[ToothJockey]

Not just at the corp offices. This applies to private practice owners, who hire associate dentists, as well. Dentistry is a business and like any other businesses, the dentist owners want to make as much profit as possible and pay their associate as little as possible. This is not being greedy. You will understand when you become an owner and have to pay bills (student loans, associate salaries, staff salaries, supplies, rents etc). I used to criticize my employers for being greedy. Now that I am an owner, I change my thinking.

I think corps make atleast 100k-200k off each of their GPs if they are paying 500/day. These corps have really low overhead, if a GP produced 600k, the overhead is probably around 300k (50%) or less, and they pay the GP 120k, so they get to take home 180k for themselves. I imagine they probably make even more money off the specialists.

 

[charlestweed]

I think corps make atleast 100k-200k off each of their GPs if they are paying 500/day. These corps have really low overhead, if a GP produced 600k, the overhead is probably around 300k (50%) or less, and they pay the GP 120k, so they get to take home 180k for themselves. I imagine they probably make even more money off the specialists.

I don't think they have low overhead. Most of their offices are located in desirable locations (high visibility, right off the freeway exits, busy strip malls etc). Their office rents are easily 5-10 times higher than what I have to pay for mine. I currently pay $2600 a month to rent a tiny 1700sf office space in an inconspicuous location. Corps hire a lot more employees: CEO, presidents, VPs, regional managers, local manager, attorneys, billers, receptionists, associate dentists, dental assistants etc . Corps have to pay health insurances for their employees while most private practice owners don't have to. In order to produce the same $$$, their associate GPs have to see a lot more patients than the private practice dentists because corp offices accept mostly low pay medicaid and HMO plans. Higher patient volume = higher overhead. Many of their offices are losing money.

 

[ToothJockey]

I don't think they have low overhead. Most of their offices are located in desirable locations (high visibility, right off the freeway exits, busy strip malls etc). Their office rents are easily 5-10 times higher than what I have to pay for mine. I currently pay $2600 a month to rent a tiny 1700sf office space in an inconspicuous location. Corps hire a lot more employees: CEO, presidents, VPs, regional managers, local manager, attorneys, billers, receptionists, associate dentists, dental assistants etc . Corps have to pay health insurances for their employees while most private practice owners don't have to. In order to produce the same $$$, their associate GPs have to see a lot more patients than the private practice dentists because corp offices accept mostly low pay medicaid and HMO plans. Higher patient volume = higher overhead. Many of their offices are losing money.

Thanks for the insight. I always thought they had lower overhead because they can get much cheaper equipment since they buy in bulk.

 

[charlestweed]

Thanks for the insight. I always thought they had lower overhead because they can get much cheaper equipment since they buy in bulk.

Having worked for the corp for more than 15 years, I've seen them make a lot bad business decisions :

- 8-9 years ago, they expanded the office by annexing the out-of-business 1600sf pizza store next door. There were already 11 chairs at the existing space and they wanted to add 7 more chairs. They spent more than $400k for this project and the material they used were just average. I spent under $100k to build my office with similar square footage and mine looks a lot better. That was not the only mistake. Now their office becomes too big and there are not enough patients fill all the chairs....they have lost a lot of patients due to openings of other new dental offices nearby.

- 2 years ago, they rennovated another office, where I also work at. They converted 8 cubible-style operatories to a 6-chair open bay treatment area for ortho + 2 private operatories for OS. They spent nearly $250k for this project. IMO, that was a ridiculous amount of money. The design was really bad. The OS operatories are too small for wheelchair access. The OS has to use the ortho bay area to treat his patients. Luckily, the OS and I work on different days.

- Also about 2 years ago, the corp spent hundreds of thousands of dollars to buy the Itero intraoral scanners for us to do invisalign treatments. Now most of these Itero machines are sitting in the corners collecting dust.

- Starting this new year, my corp raises the ortho treatment fee again to $4700 a case...12-month, 18-month and 24-month cases all cost the same. When they raised the fees 2 years ago, the start numbers have declined significantly. I used to see 80+ patients a day. Now, I only see 50-60 patients a day. I thought they learned a lesson and would lower the fee. I guess not. I don't mind since I get paid the same for sitting around doing nothing.

The only "good" decision that they made was switching from paying their associate GPs a fixed per diem rate to paying 23% of the production. This should help the corp save a lot of money but it's definitely bad for the associate GPs. That's why there is a high turnover rate.

 

[P7898]

Dont ever work for an office paying less than 45 percent of production.

Are we talking about gross production or production after insurances (adjusted production)?

 

[ibuprofen400mg]

Are we talking about gross production or production after insurances (adjusted production)?

Adjust production. This should be 98~99 percent close to production though in a cooperate office.