Dental Environments

[2thDoc11]

I’m just curious as to where all dentists are able to practice and if it depends on whether or not they are a specialist as well as what is expected given the environment/responsibility? Pretty common to hear private practice and DSOs but what about other settings? Nonprofits, clinics, small medical centers, hospitals, group practices.. what options are there for people who may not want to own a practice or jump into a corporation? what’s expected and what will it affect?

I still have an interest in the medical field so I think it’d still be really interesting to be involved in some way. I know the OMFS can be apart of that scene but do general dentists get much of it? Is that really rare? Where all can they practice if they don’t want to be own or join a DSO?

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[Molar Whisperer]

IMO, the best dental work environment is Private Practice and the worst is Corporate Dentistry. Having a sustainable Private Practice is very location dependent. Around my area in the Pacific NW, it is common for practices to not see positive income (starting from scratch) in the first 5 yrs. I've worked for Corp for 19 yrs. Today was one of the days I wished I wasn't a dentist. I work in a predominant Medicaid Capitation clinic. I have no problems doing dentistry. Our schedules are pretty tight. My problem is with the brand new PITA patients They have the hardest time filling out paperwork. By the time they'd semi completed it, we're 30 min late. I had to try to diagnose the source of extreme pain from a repressed lady from Afghanistan. Only through her husband, there was no communication from that lady. Her mouth was full of exotic bridge abutments, pontics, and cantilevers in varying conditions of recurrent decay. Then the communication nightmare begins. "How am I suppose to function? I paid a lot of money for those bridges. Can't you give me some medicine to cure it?" I had to see additional new ER pts that are a pain to manage such as Parkinson's, wheelchair bound morbidly obese, drugged out meth addicts, and another unrealistic foreign patient that would all take forever with their paperwork. It was hard to catch up.

For alternative dental environment, I only have anecdotal and speculative ideas of Indian Health Services that may be intriguing. As stated at another post, an endodontic acquaintance's co-resident practices at an Indian tribe in S. Dakota for 3 months of the year for $250k. Speculatively, Tribal income seem to come from casinos and they may have lucrative and generous employment packages. However, their locations are mostly in remote areas.

 

[Mauricio45]

As a general rule,

Private office ownership > Corporate associateship >>>>>>>>>>>>>>>>>>>>>>>> Private office associateships

 

[2thDoc11]

whats wrong with private practice associateships?

 

[Mauricio45]

whats wrong with private practice associateships?

Basically, you can't work in close proximity to your boss. Staff will never work hard for someone that is not signing their paycheque. They will shuttle off all the high prodn cases to the owner (i.e. the one who is responsible for their salary) even if you diagnosed it and discussed treatment with the patient. Owner will always favor his/her staff over associate because it's incredibly difficult to find a good assistant or hygienist. So, that leaves the associate to be right at the bottom of the hierarchy. It's a pretty crappy feeling knowing you went to school for 8-10 years and paid 500K in tuition fees only to be lower than an assistant or hygienist in a private office.

At least with the corporation I work at, when I walk into the office, I'm the only doctor there so the staff answers to me because I am the only doctor there that day. Owner is hardly there (except 1-2x a month to do IV sedation cases). That is a good political position to be in as an associate. Despite some issues with corporation, it's a hell alot better than being an associate at a private office.

But the best is to own your own office that way you have total control.

 

[Molar Whisperer]

As a general rule,

Private office ownership > Corporate associateship >>>>>>>>>>>>>>>>>>>>>>>> Private office associateships

True that.

 

[2thDoc11]

Do you have any knowledge about working with hospitals or is that pretty much only omfs

 

[Mauricio45]

Do you have any knowledge about working with hospitals or is that pretty much only omfs

No idea about hospitals. Never heard of a hospital dentist.

 

[Saddleshoes]

Do you have any knowledge about working with hospitals or is that pretty much only omfs

Hospital Dentist = GPR! (General Practice Residency)

 

[allDAT]

Clinics are hit or miss and for new grad right now, the compensation may not be high enough to support their loans, even with NHSC or IHS loan repayment programs which have offered the same benefit for more than 5 years despite rising costs in education.

IHS sites are often too remote for the long term. In general, I don’t recommend them. Community clinics can be okay, but you’re better off as a PT dentist there and a PT dentist in a private office IMO.

 

[allDAT]

I should probably elaborate a bit more. If you don’t want to own a practice or work for a DSO, you can be an associate in a private practice. The private sector had its drawbacks, and long term associates are often dissatisfied if you’re expected to be the main source of income for your household. If you only plan to work 3 days a week making an average compensation, you can be a long term associate in a private office without much headache (it just takes time to find a good one, and you must be willing to move and/or commute).

Alternatively, FQHCs can be okay. They’re not great, but not terrible for the new dentist. Unfortunately, even when you find a good one, a change in management can make a good gig terrible in a few short months. Often the volume of patients a dentist is expected to see at an FQHC results in burn out after a few years.

Indian Health Clinics are often too remote to have a life of your own. They are also hit or miss with regards to the organization’s management.

With regards to FQHCs and IHS, you’re often doing a lot of acute care and routine restorative. Some IHS clinics will have access to more advanced treatment like implant placement, but the complexity of the dental needs and the way the sites are managed (or incentivized to be managed) prevents dentists from completing advanced cases with complex restorative solutions.

There are civilian offices on some military bases that employ dentists.

There are dental schools and/or satellite facilities and residency programs.

There’s the CE circuit if you want to really move away from practicing full time.

You can work for a dental insurance company.

With all that said. If you don’t want to own your own office, I would highly recommend specializing.

 

[2thDoc11]

I should probably elaborate a bit more. If you don’t want to own a practice or work for a DSO, you can be an associate in a private practice. The private sector had its drawbacks, and long term associates are often dissatisfied if you’re expected to be the main source of income for your household. If you only plan to work 3 days a week making an average compensation, you can be a long term associate in a private office without much headache (it just takes time to find a good one, and you must be willing to move and/or commute).

Alternatively, FQHCs can be okay. They’re not great, but not terrible for the new dentist. Unfortunately, even when you find a good one, a change in management can make a good gig terrible in a few short months. Often the volume of patients a dentist is expected to see at an FQHC results in burn out after a few years.

Indian Health Clinics are often too remote to have a life of your own. They are also hit or miss with regards to the organization’s management.

With regards to FQHCs and IHS, you’re often doing a lot of acute care and routine restorative. Some IHS clinics will have access to more advanced treatment like implant placement, but the complexity of the dental needs and the way the sites are managed (or incentivized to be managed) prevents dentists from completing advanced cases with complex restorative solutions.

There are civilian offices on some military bases that employ dentists.

There are dental schools and/or satellite facilities and residency programs.

There’s the CE circuit if you want to really move away from practicing full time.

You can work for a dental insurance company.

With all that said. If you don’t want to own your own office, I would highly recommend specializing.

Thank you for all the info! I appreciate it

 

[Rambunctious]

Basically, you can't work in close proximity to your boss. Staff will never work hard for someone that is not signing their paycheque. They will shuttle off all the high prodn cases to the owner (i.e. the one who is responsible for their salary) even if you diagnosed it and discussed treatment with the patient. Owner will always favor his/her staff over associate because it's incredibly difficult to find a good assistant or hygienist. So, that leaves the associate to be right at the bottom of the hierarchy. It's a pretty crappy feeling knowing you went to school for 8-10 years and paid 500K in tuition fees only to be lower than an assistant or hygienist in a private office.

At least with the corporation I work at, when I walk into the office, I'm the only doctor there so the staff answers to me because I am the only doctor there that day. Owner is hardly there (except 1-2x a month to do IV sedation cases). That is a good political position to be in as an associate. Despite some issues with corporation, it's a hell alot better than being an associate at a private office.

But the best is to own your own office that way you have total control.

That is unbelievable false. Your staff will work hard for someone they respect, so for you to say that, I can only tell that you do things to which your staff doesnt like. I see you on this forum complaining a lot about the owner where you work and the staff doesn't get along with you, why dont you quit and do your own thing? Dont come on here telling people that associate jobs are worse than corporate because that is crazy far from the truth.

 

[I_Love_Huskies]

That is unbelievable false. Your staff will work hard for someone they respect, so for you to say that, I can only tell that you do things to which your staff doesnt like. I see you on this forum complaining a lot about the owner where you work and the staff doesn't get along with you, why dont you quit and do your own thing? Dont come on here telling people that associate jobs are worse than corporate because that is crazy far from the truth.

He's actually not far off. I've read many horror stories on DT about bad associateship gigs. Both private office and corps. Can't really generalize both ways. There are good corps but bad private offices and vice versa. It's also very individualized too as some people are better personality fits in certain offices but may not work out in another office.

However, it is my understanding that associateships in general are never really meant to be a long term thing anyway (unless owner is close to retirement and associate wants to buy office). People usually stick around 1-2 years and then leave to buy their own office. So, I can see why staff doesnt really respect the associate. From what I've seen, it seems rare to find an associateship gig last for more than a couple of years. Not to mention, most private office associateships cannot provide full-time work for two dentists; hence, why so many of them fail.

 

[Rambunctious]

He's actually not far off. I've read many horror stories on DT about bad associateship gigs. Both private office and corps. Can't really generalize both ways. There are good corps but bad private offices and vice versa. It's also very individualized too as some people are better personality fits in certain offices but may not work out in another office.

However, it is my understanding that associateships in general are never really meant to be a long term thing anyway (unless owner is close to retirement and associate wants to buy office). People usually stick around 1-2 years and then leave to buy their own office. So, I can see why staff doesnt really respect the associate. From what I've seen, it seems rare to find an associateship gig last for more than a couple of years. Not to mention, most private office associateships cannot provide full-time work for two dentists; hence, why so many of them fail.

I agree with you that it is case specific, but this guy was generalizing that associateships are just plain worse, which is incorrect.

 

[Mauricio45]

That is unbelievable false. Your staff will work hard for someone they respect, so for you to say that, I can only tell that you do things to which your staff doesnt like. I see you on this forum complaining a lot about the owner where you work and the staff doesn't get along with you, why dont you quit and do your own thing? Dont come on here telling people that associate jobs are worse than corporate because that is crazy far from the truth.

Is it really? How many times have we heard associates complain about being screwed over by owner at private offices or staff issues and complain that they "aren't busy enough"? So, they quit and either go to corporation or start their own business? So, it's really no surprise more and more new grads these days are going to corporations. Don't just take my word for it, go read the many horror stories on DentalTown about private office associateships (owner/staff cherry-picks high production cases from associate's schedule, screwed over on last paycheque, staff who never really respects associate, etc). Those are common issues. I'm sure you have heard that private office associateships have a high failure rate. They can't all be from "bad associates". Like someone above said, it's rare to see an associate stick around for at least 2 years. Sure, corps have issues too but not all of them are the same. Some are actually decent places to work for where they don't hound you on production like Aspen Dental which is a horrible DSO.


For your info, I currently work two associateships about 3.5 years now, one at a private office as an associate and the other in corp, so I get best of both worlds. Lucked out with great associateships but many people aren't so fortunate, so they go own (which is what I eventually plan on doing). It's a "needle in a haystack" to find a good paying private office associateship job (especially full-time) where you are treated with respect. I've had a "dud" in the past but this seems to be common with many associates until they find a good "fit".

 

[2TH MVR]

I'm not sure anyone can make any blanket generalizations regarding Associateships. Associateships remind me of the classic Clint Eastwood movie:

"The Good, The Bad, and the Ugly" Most of you are probably too young to remember this movie. lol. It's a classic. Clint Eastwood has always been my hero.

 

[yappy]

That is unbelievable false. Your staff will work hard for someone they respect, so for you to say that, I can only tell that you do things to which your staff doesnt like. I see you on this forum complaining a lot about the owner where you work and the staff doesn't get along with you, why dont you quit and do your own thing? Dont come on here telling people that associate jobs are worse than corporate because that is crazy far from the truth.

In my experience, the quality and cooperativeness of dental assistants has been a mixed bag. I respect and appreciate the hardworking, dedicated ones that have empathy for patients and realize their role as a health care professional. Unfortunately, many of the dental assistants I've worked with are lazy, entitled, like drama, and have bad attitudes for a workplace. I think the reason for the variability amongst dental assistants is because, at least in my state, there is not a high bar for the position and the job field lends itself to high turnover. I wish that there was an economic model that elevated their pay and credentials to weed out the bad actors so dental offices could become a more professional environment, but I digress.

To your point, its's not just associateships. DSO, or even solo private practice can have employee issues. However, as an associate you don't have much control. If the owner does not hire well, is a doormat to terrible people, or doesn't cultivate a cordial work environment for everyone, the office suffers. Some people don't give respect or work hard because that's who they are. That environment will be toxic for a newer dentist no matter what they do.

 

[pubhealthdent]

Hospital dentistry is a thing. Many FQHCs have dentists who have privileges at local hospitals to do OR sedation cases (mostly special needs or medically complex cases)

FQHCs are also a great way to get your feet wet and get some loan repayment while you're at it. You can build up your speed for a couple years and then move on to private practice if that's where you eventually want to end up