Dental corporations pros and cons; debt alleviation

[gunnyworms]

Hi dentistry forum,

I was wondering what it's like to work for a corporate dental office. The 400-500k debt scares me, so I was hoping that corporate dentistry could pay off some of the debt (which I heard could be true for some dental corporations). What are some of the cons that should deter someone from pursuing corporate? Is it worth it to hang in there, in knowing that there might be some alleviation to your debt for the corporations that do offer it?

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[ysrebob]

Gunny,

In corporate your pay is directly correlated to your production (e.g. 25-33% of what the office collects on your patients, usually towards the low end of that range). The corp's incentive is to maximize your production, which also happens to maximize your pay... so in that sense your personal welfare aligns well with theirs. Fairly large earnings are possible.

Problem is twofold:

1. For most mere mortals, $ production is INVERSELY correlated to quality of work. I.e. to crank out $6 or $10K+ worth of dentistry a day, you will be rushing and may start to lower your personal standard of what's OK work. Especially early in your career when your skills are developing and it takes you longer to do anything. Most patients will never know the difference (except they will think they have "bad teeth" because they're always needing more work done). There is a wide range of quality among different dentists' work, and I have seen some SHOCKINGLY crappy dental work come out of corp chains. To be fair, you could say the very same about some private offices. The main difference is that in corp nobody in the office is going to be all that concerned about the quality of your work (it's your license on the line, not theirs), whereas in a good associateship the owner dentist ought to care some because his name is on the door, and as an owner yourself same thing. So it doesn't have to, but corporate has the potential to make you sloppy.

2. Production is also correlated to how much dentistry you can talk patients into "needing." They really don't know -- at the end of the day they just need to trust your word. This puts a high ethical burden on every dentist, one that some people handle better than others. In a private office, your conscience (however strong or weak) is bolstered by the need to protect your reputation over the long haul: your name is on the door. Most patients will never know the difference, but a few will catch on. When you work quasi-anonymously for Big Smiles Dental Inc or whatever, your conscience is going to be more sorely tested because (a) your name isn't on the door so what do you care, and (b) in many corp offices the office manager, your boss, and everybody else up the chain from you will be actively pushing you, sometimes pushing you very hard, to diagnose more dentistry and sell bigger treatment plans.

At the risk of offending, I will venture (from personal observation over years and years in this field) that some very financially successful dentists are either sloppy dentists, con artists, or both. Not uncommonly, either. IMO corporate dentistry can more easily seduce you into one or both camps.

Still not a bad way to start a career, and not every corp chain is the same - far from it. Some are quite good. But some others will IMO ruin you unless your personal standards are high.

 

[Cold Front]

Corporations will always tell you that they will have some sort of incentive to pay your student loans. In REALITY, those incentives will come out of the work you do at a corporate office. They don't have a check just waiting for you with your name on it. It's best to use corporate offices as a stepping stone to open your office after couple of years. That's what I did, and it worked out well for me.

 

[P0W3RL1FT3R]

You can work less and earn more in private practice because you’ll also get a cut of the hygiene production.

If you’re in 300k+ debt, you better be studying up on your business and listening to podcasts so you can build a successful dental practice.

 

[Big Time Hoosier]

You can work less and earn more in private practice because you’ll also get a cut of the hygiene production.

If you own the practice.

Big Hoss

 

[MaxAnn]

Corporate dentistry is a real **** show. I would avoid working in one of those places at all costs. The turnover rate is very high from the front to the back including docs, which should tell you something. Also, you don't want to be controlled by someone they anointed as a manager who generally has more retail experience than dental. There's a good reason some corporate chains are always hiring and that's because associate dentists are always leaving. Look somewhere else to begin your career.

 

[TanMan]

Hi dentistry forum,

I was wondering what it's like to work for a corporate dental office. The 400-500k debt scares me, so I was hoping that corporate dentistry could pay off some of the debt (which I heard could be true for some dental corporations). What are some of the cons that should deter someone from pursuing corporate? Is it worth it to hang in there, in knowing that there might be some alleviation to your debt for the corporations that do offer it?

I think corporate is a great place to make into your own personal training ground. You'll develop skills, speed, learn the management/workflow, and learn what works and what doesn't work clinically, while making a good amount of money. As long as you focus on your own goals and not the corporate goals, you should be fine. It's even better if your goals and corporate goals are one in the same (make as much money as possible), because there is less conflict. Eventually, you will realize that you could be taking home more of the pie (production) and want to open your own office.

Downsides to working in corporate are less autonomy, waking up earlier, little control on materials/scheduling, and competency of DA's. I think it's totally worth going into corporate if you don't have the means to open an office immediately and you're going into a profitable corporate location. Corporate is something I wouldn't recommend in the long-term, but when you first get out, it's a great way to build up capital for your own office and/or pay down your debts.

I haven't heard offices offering loan forgiveness or repayment bonuses, but I'd rather take one that offers more cold hard cash.

 

[2TH MVR]

Agree with everyone here. Corp is an option as a starting point, but as a young dentist ..... you don't want to stay in Corp for a long time. I call it "Corporate Institutionalized". Your standards "can" start to erode if your professional ideals are not intact. Mine are. Start with Corp and immediately start looking for a practice to buy or start up. Work BOTH to keep revenue coming in. Quit the Corp as your practice grows.

I work PT/FT for the Corp. Perfect for my situation (semi retired). The money for an Orthodontist is actually pretty good. I've had some shockingly good paychecks that were close to some of my best paychecks in private. 401K. Family Medical/vision insurance. Paid CE. Paid Malpractice. Lots of nice benefits. Less stress than private practice. As a seasoned ortho .... the work is simple.

 

[theleatherwalle]

I worked corporate up until 6 months ago. Corporate is hell....It is a guaranteed pay check. You will deal with office managers who think they are your boss, you will have incompetent staff, you will deal with verbal abuse from patients. Don't think of yourself as a doctor because they will treat you like a used car salesman. Get in then get paid then get out and keep your head low. Dentistry is in a tough place currently, and you will have to just work and find a good environment to make a living.

 

[charlestweed]

You don’t learn much when everything (good polite staff, ideal supplies that never run out, well-controlled schedule, patients who respect you etc) is provided for you. Working at Corp office forces you to teach yourself to work more efficiently so you don’t fall too far behind. It forces you to learn how to make a lot of patients happy at the same time. You learn how to deal with disrespectful patients and staff… and make them happy. Working with slow lazy incompetent assistants forces you to do more things by yourself and helps you become a faster better clinician. When you are ready to set up your own office, you will be able to do many things by yourself… you won’t need to hire a lot of staff….you won’t need to buy a lot of fancy stuff….and keep the overhead as low as possible.

Another benefit of working for the Corp is good steady income. Private offices may not have enough patients to keep you busy. To compensate for slow schedules and low production, the owner doc of private office will find ways to reduce the overhead such as cutting down your work days, reducing your production percentage, or letting you go.

You won't learn much working at easy places like government-run clinics and prisons, where there a lot of waste and abuse, staff who don't care...and all you do is drill, fills, extractions...no rct, no crown, no veneer, no implant.

 

[RYost234]

Sorry to bump a month old thread, but what could a new grad expect to make if he/she started out corp as opposed to working as an associate?

 

[ysrebob]

Sorry to bump a month old thread, but what could a new grad expect to make if he/she started out corp as opposed to working as an associate?

Depends mostly on the local market. New grad Corp salaries should be roughly comparable to busy private associateships (value of your labor isn’t really dependant on type of employer). Corps are more willing to hire a new grad vs best private associateships will be looking for experience. That makes the decision for many.

As a gross generalization, starting is maybe $5-600/day in typical markets, down to low as 350/day in saturated markets like SoCal. As your speed picks up you shift to %collections, maybe 32% to 25%. At that point dentists’ earnings start to diverge widely depending on talent/speed/aggressiveness and generalizations are less applicable.

Best is to call some of last year’s grads from your school for a local view.

 

[2TH MVR]

You also have to factor in Corp sponsored medical and vision insurance, 401K, paid malpractice ins, paid CE. Good associateships may provide this, but most probably don't. Corps also means you have other GPs and specialists in the same facility to consult with.

In Corp setting ... You will learn speed and efficiency. In a GOOD associateship ... With a good mentor (unicorn maybe?).....you can learn dentistry and maybe more important ..... running a small business.

One last thing. I believe there are less strings attached to working at a Corp. Yes ... You sign a contract (1 or 2 yrs), but afterwards ... You can leave if you want. Most associateships are going to have you sign a non-compete covenent. Sometimes a breakup can be sticky.

Again.....your own private practice should always be your goal.

 

[RYost234]

Thank you both for replying! I learned a bunch. If your primary goal is to eventually open up a practice, do you think it would be more beneficial to start in corp or as an associate?

Based off what @ysrebob said about good private associateships being difficult to obtain due to the lack of experience as a new grad, it sounds like finding a unicorn mentor would be rather unlikely.

 

[2TH MVR]

Corp is just a job with no strings attached. Associateships: you are 2nd tier to the owner dentist, staff and the patients. Everything you do will be compared to the owner dentist who is GOD in that practice.
So ... The answer to your question really depends on your personality. I am biased. I would not want to work for another dentist or orthodontist. That's just me. When I graduated ... I associated for 4 months and hated it. A month later ... I bought into a partnership. 18 months later .... I bought out my partner. I like to do things MY WAY. Again .... All personality.

In a perfect world. You would associate with a retiring dentist for 6 months .... Then buy him/her out. 6 months to "test drive" the practice. Then establish a value for the practice.

Other options. Work Corp and start a small, low overhead private practice. Find a mentor to help with running your practice. Quit Corp when your office is doing well.

 

[RYost234]

Very interesting.
If one were to be in the perfect world associateship example, would 6 months be enough time to learn how to properly run a dental practice?
I'm sure it varies per dentist depending on how eager they are to learn and on how willing the retiring dentist is to help teach, but I would've thought most people would associate for a year or more before taking the next steps.

Although I do understand the desire to take over early to start making a higher income.

 

[promolion]

Corp is there to make money off of you while you break your back for them. I was in corp for 2 years and didn't really make a dent in student loans. Bought a practice and I'll probably finish my student loans in 2-3 years with equity built into the practice. Dentistry is definitely not what it seems after you graduate.

Oh. And I had 400+ when i graduated. just live frugally

 

[Garett24]

Corp is there to make money off of you while you break your back for them. I was in corp for 2 years and didn't really make a dent in student loans. Bought a practice and I'll probably finish my student loans in 2-3 years with equity built into the practice. Dentistry is definitely not what it seems after you graduate.

Oh. And I had 400+ when i graduated. just live frugally

Were you not happy that you did corporate to get your hands hot? Where do you currently reside and are you a supergenius/ top of your class?

Thanks

 

[promolion]

Were you not happy that you did corporate to get your hands hot? Where do you currently reside and are you a supergenius/ top of your class?

Thanks

Definitely wasn't on top of my class. Probably in the middle since I knew I didn't want to specialize. Success after dental school is getting patients to accept treatment and like you enough to come back. Clinical skills is also important since they do not want to be in pain or keep coming back for treatments.

As for corp, I was not happy in terms of how they treat me. But I used them for whatever I could and bounced. I would do it all over the same way since it got me to where I am. You will definitely get fast as they keep wanting more production and push you beyond your limit.

 

[Afterhoursdentist]

Hi dentistry forum,

I was wondering what it's like to work for a corporate dental office. The 400-500k debt scares me, so I was hoping that corporate dentistry could pay off some of the debt (which I heard could be true for some dental corporations). What are some of the cons that should deter someone from pursuing corporate? Is it worth it to hang in there, in knowing that there might be some alleviation to your debt for the corporations that do offer it?

Corporate dentistry is well marketed ponzu scheme. Do a military or public service program that offers loan repayment before taking a corporate job. You will get more experience and not have a “business associate” with a high school diploma breathing down your neck forcing you to “produce”. You will know when you are ready to own your own practice when you are ready and confident enough to put your name on it.

 

[RootRadar]

When I was in dental school and a new grad, I was certainly someone that had a negative view of corporate dentistry. We all hear about their for-profit business model. My stance has softened quite a bit over the past few years. These are my new thoughts (although I never worked in corporate before):

1. The truth is all private practices are for-business too. A lot of corporate problems can be seen in many private offices as well.
2. As 2TH MVR, a huge incentive to work for corporate, that is often overlooked, are the benefits! In private practice, you not only have to pay for a lot of your insurances and retirement funds yourself, but you also have to take the time to do it.
3. Consistent pay is a big benefit for corporate dentistry. You may not always be busy if the office is located in a rural area, but the baseline pay is a nice safety net, especially if you have a family.

 

[2TH MVR]

Corporate dentistry is well marketed ponzu scheme. Do a military or public service program that offers loan repayment before taking a corporate job. You will get more experience and not have a “business associate” with a high school diploma breathing down your neck forcing you to “produce”. You will know when you are ready to own your own practice when you are ready and confident enough to put your name on it.

It's just a job. No one is breathing down your neck. Seriously .... regardless if you work Corp or Private .... if you do not have the beans to want to produce and work hard .... you will never succeed in Corp OR Private Practice. Running a small business (Private Practice) is no easy task. You have to produce every month to pay your bills. EVERY month. Your bills do not care if you had an off month with low production. Overhead is always there and is usually increasing. You do the math.

I'm not suggesting over-diagnosing. Dentistry is not black and white. Diagnose and treatment plan a few different options. Not every patient can afford EVERYTHING.

EVERY job regardless pushes their employees to produce. Well ...except the govt.

 

[Afterhoursdentist]

I agree with your statements, which made me realize that I am speaking from a perspective that not many relate to. When I speak about private practice I am referring to my own practice that was passed on to me by my father and was passed on to him by his aunt. Thank you for!

 

[D1ForLifeSon]

I think we over stress about student loans.. Not saying it isnt an issue.. But there are a lot of options with PAYE, REPAYE etc.. If that is still a huge concern for you, go Military. Even the Army Reserve is offering like 240k student loan repayment to dentists these days. Corporate would be on the absolute bottom of my list for a lot of reasons. My approach to paying my student loans is to be make more money - get into ownership, learn advanced procedures (implants, bone grafting, perio surgery etc), learn hot to run a business (valuate a practice, read and understand a P&L, implement systems in my practice, Tx planning and Case presentation CE etc..)