Dental Assisting Profession is Disappearing

[charlestweed]

You paid a DA almost $40/hr before payroll taxes! That’s the highest I’ve ever heard. Very steep!

Also, working for some DSO offices can suck as much as working for some private practices. DSO’s are hiring 50-100 DA’s a week on average, but they could also be losing half of that for the same period. They are in the retention game 24/7, and will throw money at hiring new assistants at competitive rates. Just look at dental assistants on YouTube and social media, they discuss how to game the system to their advantage regularly.

I still think we currently have too many dentists per assistant, and it will only get worse unless assistants are paid $25+/hr nationwide moving forward. Sink or swim pressure for dental offices. If the pay increases, a lot of people will leave Walmart, Target, Chipotle, Amazon and the likes to look into dental assisting as a career. In the meantime, finding a dental assistant will continue to be a frustrating cul-de-sac for dentists.

I pay my part time ortho RDAs $40/hour or $160/day (we only work 4 hours a day, 11 days a month). For the assistant, who can make the essix retainers very fast, I pay him $50/hour or $200 a day. Paying these guys and gals that much per hour is still a lot cheaper than hiring a full time $20/hour assistant. Most of my part time assistants work at other orthodontists’ offices. Because most ortho offices (even at some busy corp offices) are not opened 5 days/wk like the general dental offices, these assistants can’t get full time work hours. And therefore, they come to work part time at my office to supplement their incomes. And many of the ortho assistants would rather do that (traveling to work for different bosses) than going back to assist the general dentists. Perhaps, this explains why there is a shortage of DAs….they all go work for the orthdontists (it's a joke).

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[charlestweed]

I missed this earlier. I have one who is also doing exactly this. I literally dropped my jaw that she can glue who knows what onto people's eyes in her basement with no oversight yet she needs 324963240 exams and licenses to become a full blown RDA. (I haven't looked into if there are any licensing requirements for this eyelash thing.) Today I just paid for this same assistant to take the Infection Control exam, 300-something dollars for just the first of 4 exams plus a licensing fee to become an RDA! Someone is going to unfortunately need to lose an eye or two for this latest "trend" to shut down.

It is very generous of you to pay for your assistant’s CE class and RDA exam. She must be your very good and loyal assistant. My part time RDA also has a side business at home. She is selling pet supplies on Ebay and Amazon. It’s good that she earns money from her Ebay/Amazon business. I don’t have to worry about losing her for not offering her full time hours.

 

[PerioDont]

I pay my part time ortho RDAs $40/hour or $160/day (we only work 4 hours a day, 11 days a month). For the assistant, who can make the essix retainers very fast, I pay him $50/hour or $200 a day. Paying these guys and gals that much per hour is still a lot cheaper than hiring a full time $20/hour assistant. Most of my part time assistants work at other orthodontists’ offices. Because most ortho offices (even at some busy corp offices) are not opened 5 days/wk like the general dental offices, these assistants can’t get full time work hours. And therefore, they come to work part time at my office to supplement their incomes. And many of the ortho assistants would rather do that (traveling to work for different bosses) than going back to assist the general dentists. Perhaps, this explains why there is a shortage of DAs….they all go work for the orthdontists (it's a joke).

I have met several new grad associate DMDs making $40/hr. All outside Cali though.

 

[Cold Front]

I have met several new grad associate DMDs making $40/hr. All outside Cali though.

This is another reason of many why dentistry is heading in the wrong direction. The inverted curve so to speak. Soon, a lot of assistants and hygienists who know they make more than their dentist associates will feel they don’t have to respect the doctors as much, and may even cross the line by dictating certain treatment decisions. Some corporations are already using the office managers to rank higher than the dentists and have a certain final say in treatments.

A couple of pre-dents have posted on this thread so far, but the vast majority don’t know or can comprehend what lies ahead for most of them.

 

[Cold Front]

She is selling pet supplies on Ebay and Amazon. It’s good that she earns money from her Ebay/Amazon business. I don’t have to worry about losing her for not offering her full time hours.

Although most people want to make as much money as they can, I wouldn’t get too comfortable assuming your RDA will work with you long term if her side hustle continues to grow. There could be a point that she could make plenty of money from selling stuff online, and when a certain income threshold is reached, why would she work as RDA for you or any doctor?

People with side hustles do them for personal financial freedom reasons, and to replace their main job with a passive income or far less headache gig. Working as an assistant or RDA is a very difficult job. Any job in dentistry in general is difficult. Most dentists and assistants I know would rather do something less stressful, and would prefer to do it for the same level of income or more. More and more assistants are starting their own line of business; either from their homes, gig work, social media, etc. For me, I see that as a transition for them to leave dentistry.

 

[2TH MVR]

No one mentions health/medical insurance. How many private offices can offer "affordable" health insurance for their staff? When I was in PP ... it was ridiculously expensive and the premiums increased (along with the deductible) EVERY year. If the asst's are married with a spouse who has health insurance. OK then. But what if you are single or worse .... have a family with no health insurance.

Dental Corps offer very affordable health insurance. This seems to be another hit on PP offices looking to attract good help.

 

[charlestweed]

Although most people want to make as much money as they can, I wouldn’t get too comfortable assuming your RDA will work with you long term if her side hustle continues to grow. There could be a point that she could make plenty of money from selling stuff online, and when a certain income threshold is reached, why would she work as RDA for you or any doctor?

People with side hustles do them for personal financial freedom reasons, and to replace their main job with a passive income or far less headache gig. Working as an assistant or RDA is a very difficult job. Any job in dentistry in general is difficult. Most dentists and assistants I know would rather do something less stressful, and would prefer to do it for the same level of income or more. More and more assistants are starting their own line of business; either from their homes, gig work, social media, etc. For me, I see that as a transition for them to leave dentistry.

The reason this RDA has stayed with me for so long (12 years) is her Ebay/Amazon business has already been at its peak. There are some slow sale months. Everything is oversaturated. It’s not easy to make a living. Everything in life is tough. Without the steady monthly income from working at my office, she wouldn’t be able to pay her bills.

The only person that I cannot lose is my office manager. Everyone else can be replaced. Having worked for the corp for so many years, I get used to working with limited number of staff….with assistants who called in sick….with assistants who quit unexpectedly. It’s important for the doctor to have the ability to multitask; you can double your duties as a doctor and as an assistant in case someone doesn’t show up for work. Because I can’t offer my P/T staff a lot of hours, I don’t expect them to be loyal to me. I actually want them to have another job outside of my office so they can get enough hours to support their families. I helped one of them to get a P/T job at my former dental classmate’s ortho office.

 

[charlestweed]

I have met several new grad associate DMDs making $40/hr. All outside Cali though.

I guess these new grad DMD’s don’t have any student loan debt. And that’s why they are not motivated to work hard to search for a better paying job that helps them pay the bills. There's no reason for the owners pay more when these associates don't have the motivation to work hard to prove to the owners that they are worth more than $40/hour. Nothing is easy in life. The less motivated you are, the less successful you will be. According a few of my successful dentist friends, who hire associates to work in their offices, the average pay for a newly grad is $500-600 a day. And this is in CA, where it is known to be one of the worst states to practice dentistry.

 

[PerioDont]

I guess these new grad DMD’s don’t have any student loan debt. And that’s why they are not motivated to work hard to search for a better paying job that helps them pay the bills. There's no reason for the owners pay more when these associates don't have the motivation to work hard to prove to the owners that they are worth more than $40/hour. Nothing is easy in life. The less motivated you are, the less successful you will be. According a few of my successful dentist friends, who hire associates to work in their offices, the average pay for a newly grad is $500-600 a day. And this is in CA, where it is known to be one of the worst states to practice dentistry.

5-600/day is still only about 60$/hr assuming an 8hr workday...or 10$/hr more than you are paying your essix assistant.

After 8 years of schooling and literally hundreds of thousands of dollars, with tons of liability and stress.

These grads I am thinking of have large amount of student loan debts, hence they needed to accept the first available job that would hire them.

It is not that easy to get your first job, esp when you have no money to move to another city or for licensure/malpractice/boards. Then most new docs have little perspective and sign lengthy contracts as well (I've seen 3yr+ contracts)...esp when there is a sign on bonus.

Many times the owner does not have enough pt flow, materials suck, staff is hostile to new associate, unethical tx planning, no referrals allowed...the list goes on.

The new grad is in a tough position in todays dental world. High student debt, hard to find a good ethical job that will allow you to pay said debt.

IMO ownership is the only way this profession is worth the high cost of schooling today.

 

[charlestweed]

5-600/day is still only about 60$/hr assuming an 8hr workday...or 10$/hr more than you are paying your essix assistant.

After 8 years of schooling and literally hundreds of thousands of dollars, with tons of liability and stress.

These grads I am thinking of have large amount of student loan debts, hence they needed to accept the first available job that would hire them.

It is not that easy to get your first job, esp when you have no money to move to another city or for licensure/malpractice/boards. Then most new docs have little perspective and sign lengthy contracts as well (I've seen 3yr+ contracts)...esp when there is a sign on bonus.

Many times the owner does not have enough pt flow, materials suck, staff is hostile to new associate, unethical tx planning, no referrals allowed...the list goes on.

The new grad is in a tough position in todays dental world. High student debt, hard to find a good ethical job that will allow you to pay said debt.

IMO ownership is the only way this profession is worth the high cost of schooling today.

If your hourly wage is $40, your daily income is only $320/day. When you make $500-600/day....that means you make $22-35 more per hour or at least $4-6k more per month, which is a significant amount. Imagine if you pay this additional $4-6k/month + the required minimum monthly loan repayment amount, you should be able to reduce the total student loan debt amount by $50-70k every year. If new grads in CA, where it is the one of the worst states to make a living as a dentist, can make $63-75 an hour (or $500-600/day), I don’t see why the new grad DMD’s, whom you have met, can’t. Maybe they should stop bashing the corp offices and should think about working for them. Most corp offices are Ok with hiring new grads, who have zero experience, and they also pay their associates better. Some corps offer benefits like malpractice insurance, health insurance and CE classes.

IMO ownership is the only way this profession is worth the high cost of schooling today.

I agree. But before you get to this point, you need to find a place work to gain the experience first. It’s hard to be successful when you don’t have enough confidence in your clinical skills and have to refer many cases out to the specialists. All the successful owners I know had had to work for someone else first before they gained enough confidence to start their own offices.

 

[PerioDont]

If your hourly wage is $40, your daily income is only $320/day. When you make $500-600/day....that means you make $22-35 more per hour or at least $4-6k more per month, which is a significant amount. Imagine if you pay this additional $4-6k/month + the required minimum monthly loan repayment amount, you should be able to reduce the total student loan debt amount by $50-70k every year. If new grads in CA, where it is the one of the worst states to make a living as a dentist, can make $63-75 an hour (or $500-600/day), I don’t see why the new grad DMD’s, whom you have met, can’t. Maybe they should stop bashing the corp offices and should think about working for them. Most corp offices are Ok with hiring new grads, who have zero experience, and they also pay their associates better. Some corps offer benefits like malpractice insurance, health insurance and CE classes.

I agree. But before you get to this point, you need to find a place work to gain the experience first. It’s hard to be successful when you don’t have enough confidence in your clinical skills and have to refer many cases out to the specialists. All the successful owners I know had had to work for someone else first before they gained enough confidence to start their own offices.

Agreed. I think corp offices are generally 'safer' for new grads as well.

definitely have more benefits.

 

[Cold Front]

I guess these new grad DMD’s don’t have any student loan debt. And that’s why they are not motivated to work hard to search for a better paying job that helps them pay the bills.

70-80% of new dentists have student loans, 55% of them are females.

It’s 2021, Charles. Almost every new dentist is in debt, or signed a contract with the government/military to leverage that debt.

The reality is... when a new dentist starts to practice, their income is as good as their contract. It’s not uncommon for many dentists to make $500-600/day for couple of years, which is $60-75/hr. The reality is, some hygienists with far less training and debt are making $50-75/hr as well. This is today’s economic realities.

 

[Cold Front]

Without the steady monthly income from working at my office, she wouldn’t be able to pay her bills.

“Paid Work” is no longer the center piece of American life. It’s becoming less fulfilling every year for most people. We are at a time where people are eager to leave their jobs to find something they enjoy doing... and not just to pay the bills. We will look back in few years and understand that the pandemic was a big part of that decision for millions of people moving on to different jobs.

 

[charlestweed]

70-80% of new dentists have student loans, 55% of them are females.

It’s 2021, Charles. Almost every new dentist is in debt, or signed a contract with the government/military to leverage that debt.

That's what I thought too. That seems to be the same percentage of the student who took out loans as when I went to dental school years ago. I wonder why some students on this forum have said that the majority of their dental classmates are filthy rich and their parents are paying for their dental education. I don't know who are correct on this one.

The reality is... when a new dentist starts to practice, their income is as good as their contract. It’s not uncommon for many dentists to make $500-600/day for couple of years, which is $60-75/hr. The reality is, some hygienists with far less training and debt are making $50-75/hr as well. This is today’s economic realities.

That's what I thought too, especially for GP owners who practice in CA. And then there were some posters on this thread (Ortho bubble about to pop?) who argued with me that many GP owners are making way more than $1200-1300 a day.

Yes, hygienists are making a lot for the amount of years that they had to spend in school. The problem is they have to work under a boss for the rest of their life. Being a dentist, you get to be your own boss and dump all the cleaning procedures to your hygienists.....that's a nice passive income for you. Nothing in life is easy. No pain, no gain.

 

[charlestweed]

“Paid Work” is no longer the center piece of American life. It’s becoming less fulfilling every year for most people. We are at a time where people are eager to leave their jobs to find something they enjoy doing... and not just to pay the bills. We will look back in few years and understand that the pandemic was a big part of that decision for millions of people moving on to different jobs.

Nobody enjoys working or having to listen to a boss. But the reality is work is life and life is work. You can't really enjoy life if you can't pay bills. The landlord will kick you out of their apartment. The banks will tow away your car if you fail to make a payment. You may get away with not being able to pay bills if you are a single person with no kid. But when you have kids, you don't really have a choice to say no to the job you don't really enjoy. Many musicians have to work on the side in order to support their music hobby.

 

[2TH MVR]

Nobody enjoys working or having to listen to a boss. But the reality is work is life and life is work. You can't really enjoy life if you can't pay bills. The landlord will kick you out of their apartment. The banks will tow away your car if you fail to make a payment. You may get away with not being able to pay bills if you are a single person with no kid. But when you have kids, you don't really have a choice to say no to the job you don't really enjoy. Many musicians have to work on the side in order to support their music hobby.

Funny. You and I are from a different generation. I came from a lower middle class family. Neither of my parents finished high school. Working was our way to meet basic needs. We did not have a choice. And if you worked hard enough. Invested properly. Married correctly. And were lucky .... you could be affluent. Towards the end of my private practice years .... I came to the conclusion that working harder did not exactly translate into making more money. There were outside forces that no amount of work would have helped.

Point is. As @Cold Front et al has opined ..... hard work in itself may not be enough to overcome the obstacles to success. Especially in saturated areas. After a pandemic. Employees have different values now. They think differently than us. I've got one ortho asst who buys and sells vintage, unique, one-off Nike Basketball shoes. He makes pretty good money off of this. He just recently opened a RobinHood Acct and has been making a little money off of Cripto. He keeps his job at Corp for the benefits and stable paycheck.

The current gen is different. Their values are different and appropriate for them and their situation. When they see posts from us "older" guys .... they're probably being polite in listening, but are silently shaking their heads in disbelief.

Ok. Back to chasing kids off my lawn.

#OK Boomer

 

[Cold Front]

hard work in itself may not be enough to overcome the obstacles to success.

Absolutely. I think understanding the world better and working smarter are the other ingredients for the path to success. Often, people are too busy to learn new things that helps them work smarter. The barrier for many has always been “time” to actually plan for life.

The pandemic is referred to as the “Great Reset”. The lockdown was an opportunity for people to sit down and reflect on their lives. People were getting stimulus checks/getting paid by government and received generous unemployment benefits that paid more than their actual jobs.... to stay at home. Think about that, that by definition is “passive income”, and majority of people loved it. The pressure to “work hard” and pay bills didn’t apply during that period. Many people took the money and invested in a side gig, stock market, bitcoin, and learn other skills they didn’t had the time for. They used the opportunity to reinvent themselves financially. Millions of people refused to go back to work because they realized how horrible their lives were at their previous jobs. Others opened new businesses and decided to control their financial destiny more. Some went back to their jobs while they still work on their plan to break the ball-and-chain. All this summed up to over 10M jobs open in America, and probably millions more on the fence and at the edge of quitting within the next 6-12 months.

Like [mention]2TH MVR [/mention]said, “hard work” is not enough to succeed, just like “knowledge” is not enough to success either. Many young people got good advise through their parents, seniors, online, etc. They may not be articulate about their views about “hard work”, but they too understand the progress to success comes from different paths.

To circle back to dental assistants, many (including my assistants) paid off their personal debt during the pandemic and removed a lot of financial pressure through the stimulus checks and the enhanced unemployment benefits. Those who couldn’t leave the profession for financial reasons now found themselves in an early retirement. Many who stayed in the profession capitalized on the labor shortage and asked for insane pay raises. The concept of being an employee has become a great opportunity for some by having multiple job offers. In my view, all this is here to stay, assistant pays will continue to rise in the near term, and I will go as far as predicting “$50/hr” rates for assistants at some offices within the next 5 years. The good ones are getting paid $25-40 today, $50 rate is probably out there now - which if it’s full time, is a 6 figures job.

 

[charlestweed]

Funny. You and I are from a different generation. I came from a lower middle class family. Neither of my parents finished high school. Working was our way to meet basic needs. We did not have a choice. And if you worked hard enough. Invested properly. Married correctly. And were lucky .... you could be affluent. Towards the end of my private practice years .... I came to the conclusion that working harder did not exactly translate into making more money. There were outside forces that no amount of work would have helped.

Point is. As @Cold Front et al has opined ..... hard work in itself may not be enough to overcome the obstacles to success. Especially in saturated areas.

I agree that hard work alone may not be enough. There are also other factors that help contribute to one’s success such as being lucky, choosing the right profession (ie becoming an orthodontist ) and having great business skills. But if one graduates with a ton of student loans and has zero clinical experience and no business skill, he/she doesn’t really have a choice. With a lot of student loans, choosing to work at an easy slow dental office that pays $40/hour, instead of working at a busier office that pays double, is just crazy and irresponsible. At least hard work helps get a person through the difficulties at the beginning of his/her career and makes up for his/her lack of experience.

Hard work may not be enough but it can get you very far in life. Owning 4 offices and being 100% debt free at 49, I am very proud of my accomplishments. I haven’t yet met a successful person who is lazy. These successful friends of mine may not work hard now but they used to work very hard when they first started their businesses.

After a pandemic. Employees have different values now. They think differently than us. I've got one ortho asst who buys and sells vintage, unique, one-off Nike Basketball shoes. He makes pretty good money off of this. He just recently opened a RobinHood Acct and has been making a little money off of Cripto. He keeps his job at Corp for the benefits and stable paycheck.

I can tell that your assistant is a very responsible person. You don’t just give up your stable job and stable paycheck. His good Nike shoe business may not last forever. His wife and kids must be very proud of him. Being able to pay bills is not good enough....you have to save for your retirement and kids' college education. A responsible person always plans ahead and has backup plans. I too recently invested in stock and Crypto after I paid off all my debts. But I don’t count on these investments as a main way to make money. Practicing orthodontics is still my main job, which is much easier and faster way to make money.

The current gen is different. Their values are different and appropriate for them and their situation. When they see posts from us "older" guys .... they're probably being polite in listening, but are silently shaking their heads in disbelief.

Ok. Back to chasing kids off my lawn.

#OK Boomer

I think that’s because they are currently in schools and living on borrowed money. But once they graduate and start working, paying bills/taxes, getting married, and raising kids, I think they will see that we, old guys, have made some good points.

 

[Cold Front]

Owning 4 offices and being 100% debt free at 49, I am very proud of my accomplishments.

Congrats Charles. You are a machine. I want to be like you when I grow up! lol

 

[charlestweed]

Congrats Charles. You are a machine. I want to be like you when I grow up! lol

LOL. Thanks! I wish my income is as high as yours. They are just 4 small offices. Two of them are shared with 2 different GP owners. They are too small that there are only enough patients to keep me busy 11 days a month. I still have to work 10 days a month for Corp office to keep myself busy 5 days/wk. I wouldn’t be this proud if I didn’t have my own business and was just a full time associate orthodontist at the Corp office

 

[2TH MVR]

I played golf yesterday with two brothers of Asian descent (S. Korean). They both own several dry cleaning locations. We were discussing the issue with lack of employees. Not to bring politics into this, but they are disgusted with the current politics as they see that as the main issue that they cannot find employees to work. Their words. Not mine. But they felt as a small business ... they were competing directly with the govt re: wages/compensation to attract employees. Stimulus/Unemployment vs. conventional employment.

So. I have an idea to get the employees back to work. Everyone knows about sick pay. By working you earn sick pay. Most employees will use it or lose it. Therefore most employees will call in sick even if they are not sick so they don't lose their benefit. When I was in PP .... I always hated this. Therefore .... in my office we offered WELL PAY. You were compensated for not being sick and you collected the WELL PAY at the end of the year (5 days or 40 hrs). If you called out sick 1 day ... you only received 4 days well pay at the end of the year. So .... an employee was rewarded for not calling out sick.

Maybe the govt can direct some of the stimulus/unemployment funds towards getting people back to work instead of rewarding those who stay at home.

 

[Cold Front]

they felt as a small business ... they were competing directly with the govt re: wages/compensation to attract employees. Stimulus/Unemployment vs. conventional employment.

In the aftermath of events, we often look back to analyze our decisions and experiences. We compare our prior expectations of how things would pan out against our current perspective.

There are couple of flaws to the argument your pals made:

1. The enhanced pandemic unemployment ended for half the states back in May/June. The rest will end this weekend. The pandemic disrupted people’s lives deeply, specially women and minority people. We can discuss all day how the government and their decision to extend unemployment benefits last March, but it was timed until kids get back to school, so parents, specially women with children, have the help needed to get back to work. What will the argument be when unemployment ends and employers still can’t find work? The real problem is there are too many jobs open for a smaller pool of workers. Americans retired more, which means less experienced and qualified workforce... almost 700k people died of covid, millions have long covid (a disability), etc. I lost 2 uncles to covid 6 months ago (I was in the ICU with them when the decision to pull the plug was made), my patients died of covid, I know first hand how covid disrupted lives and communities. The pandemic unemployment was critical to people who were effected by covid. Yes, the system was not perfect, but no one (to this day) knows how if the covid rage will be over soon.... about 2,000 people died today (excluding Florida which is a hot zone for cases and deaths).

2. If an employer really needed help at work, they would do what corporations did - tighten their belt for a while, pay higher wages and things would slowly improve. My local McDonald’s has a banner up now saying “now hiring 14 year olds” during a school season. All employers are and will remain desperate for employees for months to come. As I said, we have too many jobs open by corporations who were not effected or benefited from the pandemic... they made so much money over the past year or so, and are using some of their profits to competitively fill positions at new facilities and are not shying away from poaching other businesses for employees. The post -unemployment benefits period will be a full blown competition between employers. Exhibit A: Aspen dental opens a brand new dental practice next to a PP dentist who is struggling to keep his/her assistants and hygienist... so Aspen offers the PP office hygienist $100k+ a year and the assistants $80k+ a year... this is hypothetical situation, but I have seen it happen. Will employers still point the finger at the government for not finding workers? Clearly not, something else will be blamed for the labor shortage.

 

[Foreverdental]

As much as I hate to admit it, being a DA sucks. The pay is too low, you are on your feet most of the day, you handle sharps and other contaminated items, the benefits are limited or non-existent, most dentists treat staff poorly, and there’s no room to grow within the practice (it’s a dead end job).

Since dental insurance hasn’t kept up with inflation, it’s put dentists in a very difficult position when it comes to hiring support staff and that’s trickled through to the DAs, and now it’s very hard to find good ones.

TRUE

 

[Foreverdental]

but you can teach a monkey to do those things... not worth 25/hr.

this is very disrespectful