Dentistry: Private Practice & Beyond - Finishing school is just the beginning

[jaxdds]

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Getting in and finishing school is just the beginning. Once you are out it is a whole other ballgame. I'll be happy to answer any questions about transitioning to private practice, patient managment, and others as they come up.

I'm currently in Maryland, working in private practice full time with 3 other DDS. I also see pedo patients one day a week in another office. We treat normal kids and those from underserved areas with medical assistance and other state and local programs.

I'll be happy to help out and answer questions as honestly and accurately as possible.

Dr. J

 

[jaxdds]

Thank you for taking the time to answer our questions.

Question: How much knowledge in business does one need to start up a private practice in dentistry? I am assuming that doing so would not require a MBA, but having a business degree wouldn't hurt, right?

Thanks

Great question. To start up a practice one needs basic business knowledge. Unfortunately in dental school you only get very limited if any of this training.

That is why in today's market, associates transition in with a practice or get the help of a dental practice managment consultant if starting from scratch.

Having a business degree or background is a definite plus and will help when it comes to practice accounting, money issues and other items pertaining to running the businnes, rather than doing the dentistry.

I know lots of dentists that love their job but hate running a business. Unfortunately it takes time to determine what your personal habits are when it comes to running the business side of a dental practice.

When running a practice you are the boss and at the same time you have to 'produce' your product, which is the dental work. In other businesses, the boss just directs employees to produce a product and oversees the operation. We do it all!!!

This is why many dentists may see patients 3 or 4 days a week. They have to attend to the business side the other 1 or 2 days or their practice and bottom line may suffer.

Dr. J

 

[jaxdds]

Hello!

I'm sort of interested in applying for the dmd/md program at Case. My main interest is in becoming a general dentist, and from what I understand, this program is designed to graduate general dentists who have an interest in somehow incorporating an md education into their career.

So my personal interest in this program is because I'd like to become a general dentist, and it would be interesting to explore how a concurrent medical education could open up new career possibilities. But realistically, as busy and broad-ranging a traditional general dentist career can already be, could there really be enough "room" to somehow incorporate and actually utilize whatever additional abilities an md license would bring? Based on your own practice, for example, if you were to have graduated with the dual degree, can you see yourself somehow incorporating and using that medical education in your current practice?

The thing is, I don't believe in applying for this program just to obtain an additional degree for the heck of it, or even for purely the challenge of it. So I'd like to find out if there really could be a niche out there for dmd/md general dentists. This is a situation where I'd have to reaaallly convince myself that it'd be worth it to pursue this program because I've hit on a truly good use for it in the future, because I'm pretty thrilled to begin with about the possibilities that already exist for traditional general dentists!! =D

ddhm,
You have posed an interesting question. The only DDS/MD that I know are oral surgeons. So having the abililty to come out of school with a DDS and medical degree without a specialty does seem very interesting. The problem lies in the scope of how you would want to practice with both degrees. In most states where an oral surgeon has a dual degree they only practice under their dental license and use the MD to gain hospital privleges and work more complicated cancer and reconstructive surgery cases.

Also, I know most of our MD colleagues have to do multi-year residency programs in order to obtain their full medical license (as each state requires) in their specialty, even if you are a family practicioner. If this program is more of an 'on paper' degree, then it would probably be just for personal benefit. If you are planning on doing research with educational institutions this degree can put you on that path as well.

Personally I can't see many patients utilizing a DDS that has an MD for general medical care. I'm sure that the extra knowledge gained in medical school will help in private practice, but so far I feel pretty competent in my general medical knowledge with just having my DDS.

As far as your question to if I had a dual degree, I am sure that it would prove somewhat beneficial, but as you stated, the scope of a general dental practice keeps you pretty busy.

In summary, I think if you are on the path to research or education and a PhD does not interest you, then perhaps the DDS/MD would be a path to take. However, take into account that you would need to do some sort of residency and choose the scope of your MD after school, whereas in most states completion of dental school alone and passing the boards allows one to practice dentistry without a residency (although I recommend one!)

I know this is just my opinion, perhaps speaking with someone who has a simialr degree or currently enrolled in the program would help. Worse case scenario, if you dislike dentistry or become disabled with your hands you have another field open to you.

Thanks
Dr. J

 

[jaxdds]

From proline
"Could you please tell us a little bit about yourself? Where did you go to school? Did you specialize (pedo?)? Are you happy with what you are doing now and happy you decided to study dentistry? What do you love about the field? What are your biggest complaints / concerns?"


Great questions, I'll be happy to provide a brief bio for you:

I received my Doctor of Dental Surgery degree from The Baltimore College of Dental Surgery, Dental School, University of Maryland at Baltimore in 2004. In 2000 I graduated from Goucher College where I received a Bachelors Degree in Biology with Chemistry. After dental school, I completed a residency program in general dentistry at the Washington, D.C. Veterans Administration Hospital and the Washington Hospital Center Oral Surgery Department

During my residency, and while in dental school, I worked with special needs patients (adult and children) and addressed their unique dental situations. I also held several leadership roles, including President of the American Student Dental Association, University of Maryland chapter. I also served as the student member on the Maryland State Dental Association Board of Trustees. At the 2005 Washington DC Dental Society meeting, I presented a research project dealing with the dental treatment of sleep apnea.

I am a member of the American Dental Association, Maryland State Dental Association and the Patuxent Dental Society.

 

[jaxdds]

I would like to ask if it would be better to get a business degree before or after dental school. I would love to run my own practice, and I feel that formal training in business would help me really launch my private practice. However, I was researching business schools and most matriculants on average have 5 years of work experience and are about 28 years old. I am fresh out of my undergrad right now w/o work experience and was considering persuing dentistry first and then pick up a business degree later on after residency or something because I would hate to delay going to dental school for so long (7+ years from now). Does this sound reasonable?

GT,
That is a good question. I would recommend to get the hard part over with first, which of course is dental school. I would also point out that less than 0.5% of practicing dentists have an MBA or advanced business degrees, so having one is definitely not the norm. I myself have pondered with the idea of getting an MBA, however, I don't think that having an MBA will let you take care of all the business aspects of your practice. When you are practicing you will realize that it is easier to hire an excellent CPA and do dentistry, as the dentistry is more profitable than going over your books. (Sort of like sending all your lab work out) Dentists are lucky now to have the Academy of Dental CPA's, check out their websites, especially Allen Schiff, CPA at www.schiffcpa.com . They offer great resources for busy practicing DDS's.
There is an execuite MBA program that the ADA offers over the course of about one year. Check out the ADA website and search for information the the Kellogg Business School executive MBA program for dentists. This program is for dentists only who want an MBA especially for their profession. I would consider this program for myself in a few years, as it requires one to take time off and it can cost about $15K.

Good luck.

Dr. J

 

[jaxdds]

I hope no one is too stressed with the new academic year set to begin😱

If anyone has any business questions or practice/patient management questions please let me know!

Dr. J

 

[jaxdds]

What is the hardest part of starting a successful private practice? I start dental school in August so I still have a few years to go, but from my point of view, if you treat your staff and patients with respect, kindnesss, being fair, give them bonuses, etc...you are going to have a successful practice right? I just don't understand why dentists can't realize this. Am I being too naive?

PlanB21,

You are on the right track. It seems that if you believe in the golden rule that every patient and staff in your practice will listen to you, follow the recommended treatment and be loyal to you. However, most dentists are idealists and perfectionists. We think that everyone should subscribe to the way we think and do things. This works good for the staff because we are the 'boss' and can train them to do what we want. One thing I've learned in my short career is to be nice to your staff, explain to them what they are doing right and wrong, and thank them for their hard work.

With our patients we cannot always get them on board with their oral health care needs. The hardest thing to do is to convince a patient to save their teeth that need extensive work (endo, crown etc) after they have already had two or three extracted. They can't see the big picture. You as the doctor have to guide them to what is best for them. I like the anaology someone told me about an 18 wheeler truck driver. If one wheel went flat, wouldn't it be ok still to drive, you have 17 wheels left. Then if a couple more went, it would not be that bad. Teeth are the same way, if you loose one or two the others have to work harder and have more stress on them. However, people don't always see it until its too late.

There are some interesting studies on patients perceptions of health care professionals that would be a good read. Over 90% of patients want a hand shake and an introduction from the doctor on their first visit. They want to hear "hello, mr...... nice to meet you, I'm Dr. Joe Tooth". But, less than half of the Dr's out there do this. Also, patients don't want to hear about your latest vacation or purchases. But, in the studies, most Dr's will tell patients that they just bought a new TV, had a nice trip to .... or other unnecessary items. Focus on the patient and tie in small things to build a relationship with them.

If it were easy to be a good dentitst and business manager then there wouldn't be all of these practice consultants out there. If you ever have looked in the trade journals or at the conference CE listings you would see just as many clinical and managment courses offered. The true fact is that very few dentists are good at both the clinical and business side of dentistry. Many get frustrated and fall into a cycle of just getting by. Others opt to be an employee dentist and work in a practice that is run by an owner dentist. The pay is a little less but for some the headaches that they had with owning a practice are worth 10-20% less in pay. It is easy to be idealistic, I still am for the most part.

 

[jaxdds]

I would like to apply to the GPR program at the VA in Washintgon, DC. However, I absolutely love prosthodontics-every aspect of it. So, at this point I'm a little torn because I would love to do a prosth program, but I'm receiving a bad vibe from a lot of people about prosth. For example that a GP can do what a prosthodontist can. Also, there are not too many jobs available for prosthodontists: I picked up the latest JADA and even when specialists are requested, they refer to OMS, ortho, endo and perio. I have grades that could easily put me into any specialty, but prosth is what I know I would love to do for the rest of my career. In the same time, I don't want to spend 3 more years in a prosth program and find out later on that I could have just done a GPR year and work on the same cases.

Jo23,

Glad to hear that you are considering the VA for a residency and getting ready to finish school. I have heard the 'prosth or not to prosth' dilemma many times before. It does seem that the realm of a general dentist is very strong in prosth. And yes, the realm of a prosth is very strong in general dentistry. For the most part, prosth is still a very viable profession and specialty. If you plan on working in an urban area such as Balt, Wash or the suburbs of either, there is a strong market for a well trained and patient friendly prosth. Also, if academia interests you now or later in your career, then having a specialty degree is almost a must for tenure track professors.

Personally, I think with implants and more complex dentistry on the rise, the need for dentists well trained in prosth will grow. Occlusion is a big part of dentistry, whether we like to admit it or not!! The only spec. I would consider an expert on occlusion would be a prosth. Not saying that a GP could expand their knowledge via CE and several courses is out of the question.

So, the decision to do a prosth residency isn't that easy. I know that just by graduating and doing a GPR you will have a firm background in Prosth, but a residency will put in place all the principles and scientific background necessary to specialize. Ultimately I would consider the final outcome. Do you want to work in a specialty practice just doing prosth (some might like not having to do perio...)? Do you want to be a general dentist with a prosth degree but not limiting your practice? Also, where you want to work comes into play. If you are further outside of a city, it might be tough to get complex cases referred to you from local GP's.

The DC VA is a good program, at least 4 years ago it was. And I know that the Prosth program will be good there. Dr. L. has worked hard to get the program implemented and have an association with the Navy PG program at Bethesda. Plus, having the Wash. Hospital Center next door is a great asset to the GPR. Regardless of what you do, good luck and let me know what you decide !!

Dr. J

 

[jaxdds]

What advice would you give to a student who would like to incorporate research into a career with dentistry? I see you attended UMaryland where they have a DDS/PhD program, what are your thoughts on this avenue? I really enjoy dentistry but would like to be involved with research as a career (ie faculty, etc) in addition to the dental portion.

Dentman,
I think there is a good case to be made for research and dentistry. If you like the research side of things then becoming a faculty member in a dental school would allow one access to different aspects of dental research, whether it be with dental materials or other aspects of the biological processes of dental heatlh.

As far as a DDS/PhD program, it is my understanding at MD dental school that you complete the preclinical dental courses then spend three years focusing on research, then pick back up with the last two years finishing your clinical dental training. There were a few at MD that did complete this and most went on to specialize afterwards. You would need to talk to a Phd Advisor to see what most grads did with the combined degree. It does make for a long seven years of dental school. As far as cost, I think most schools cover your tuition during your PhD years in school, but I would check on that.

In terms of research in private practice, there are several dental materials manufacturers that look for experienced DDS to 'test' new products in a clinical setting. They range from new bonding materials to impression techniques and metal alloys used in making crowns, ortho materials, etc... This is a good adjunct if you can establish a relationship with a company and you are comfortable using newer materials on your private practice patients.

Personally, I enjoy the private practice side of dentistry. It allows me to formulate a good relationship with patients and prescribe the most appropriate treatment for them. If you like working with patients and research then a dental school or hospital setting that allows dental research would be a good mix for you. You would be able to see patients on a limited basis, not worry about practice management, and have time and a budget given for research. All schools will require to publish your results and give updates on the status of your work. If you don't like to write then that would be a challenge. Also, you will always have eager dental students who want to do research to build their CV if they are thinkning of a specialty 🙂.

Good luck with whatever you decide. Ask a lot of questions along the way!

Dr. J

 

[jaxdds]

Dr. J,
I am a GP practicing in MN for almost 5yrs now. Well, here is my situation. I am a foreign trained Dentist and I didn't have to go to school here in the states to obtain the DDS degree. It's because MN board accepted my credentials and let me take the clinical boards.
The problem is I cannot practice anywhere else because every other state requires DDS from an accredited school. I am planning to apply for AEGD programs. I like scope of General Dentistry and doing AEGD will provide me experience with more complex cases and fine tuning my skills.
Do you think I stand a chance given I have graduated from a non-US school and with a score of 88(part 1,2001)??
Thanks,
Avi

Avi,
I understand that some states will accept a FTD if they agree to practice in underserved areas or stay in an area for a number of years. In MD they have a similar program for FTD that are pedo trained. I know of two in my area that completed an AEGD and a year of retraining in a pedo program.

I don't know the current status of most AEGD programs but I'm sure that a score in the high 80's would be competitive for most recent graduates, coupled with the fact that you are an expereinced practicioner. In my opinion you would seem to be a good applicant. With your experience you could help your co-residents in the program with you as well as pick up new skills that you might not have been exposed to yet (implants etc...). Good luck!

Dr. J

 

[jaxdds]

Hey Dr.
I am considering dental school, while I am accepted to Medical School, however, I heard some not so nice things about dentistry. First, you don't make enough money out of college, as a new graduate (Money is not my reason for dentistry, but I am going to take loans out, so I want to be able to pay it back). Second, is it hard to set up your practice? Third, How does one go about to become a dental surgeon (such as how many years of post-grad school and years of residency, and is it stressful?) Thank you for all your insight..

Toothphairy;
I understand where you are coming from. Although I did not apply to med school, I worked in a hospital laboratory for over two years while in college to gain medical experience. I was turned to dentistry when I learned that most dentists have very little emergency calls, can work about 4 days a week after becoming established in practice, and the relationship with our patients is different than that of an MD. Coupled with the fact that I love to work with my hands, fix things, and am a very visual learner, I really enjoy my profession. So, let me try to answer your questions...

1. Money is nice, but not important. You will graduate dental school or medical school in debt. That is a fact. Depending on whether you go to a private or state school will be the biggest factor in your debt load. Expect somewhere in the range of $200-300K in debt. When one finishes dental school they can work right away and start making money. When one finishes medical school you still need to do a residency, sometimes three years long. In the long run dentists earn more than most GP physicians.

2. Yes, it is hard to set up a practice. Nothing is easy in business. That is why most new DDS grads. will associate with a practice to get experience and learn the ropes. The same is true in medicine. If the relationship is successful with the practice you are in, it can turn into co-ownership and ultimately your own practice. To start a new practice from 'scratch' it can be expensive but if you choose the right location it can be quite rewarding. It is no secret that in any business the owner always makes more than the associates. However, being the owner has added stresses. I know several DDS that enjoy being an associate DDS, making 20% less, so they do not have to deal with the stress of running a business. There are several consultants that specialize in every aspect of practice startup and managment so don't worry too much about it now.

3. Oral surgery is great. Everyone has wisdom teeth. The rise of complex dental implant surgery and the aging population (unfortunately) needing tooth extraction will only increase the need for OMFS.
To be a strong candidate for an OMFS position one needs excellent grades in the pre-clinical portion of dental school. GPA of 3.5 minimally and board scores above 93 on both Part I and II are almost a must. There are two types of specialty programs. One is a four year hospital, usually a trauma center, based residency. The other is a six year school and hospital based program. During the first three years you take courses with an associated Med school, take the med school boards and when you are done you have an MD, but keep in mind that you practice is still in the realm of oral surgery. You would need to complete a medical residency in an area of interest if you wanted to practice medicine in addition to dentistry. Keep in mind, no matter what program one chooses, 4 or 6 year, you are the same specialist, limited to the same procedures dictated by your training. Some 6 year programs go into more detail on facial cosmetics but so do some four year programs. When you get to that point the programs will tell you their different aspects.

Lastly, its all stressful. In the end, its all worth it. Good luck!

Dr. J

 

[jaxdds]

OceanBlue,

This seems to be the lest talked about topic among new and expectant grads, so I'm glad you mentioned it. Most are just focused on passing boards and getting into a residency or specialty program. It's good to think about the next steps of private practice since that's what you will be doing the rest of your career, hopefully.

My opinions and advice are based on what I have seen in the past three to four years. Personally I know of only a few new grads that have set up a new practice since getting out of school. Of those, half are either ortho or endo. Most everyone else is out there either bouncing around from office to office or is just starting to 'buy-in' to an existing practice. It seems that most of us associate with a group or single dentist that is nearing the 10 to 20 year slide to retirement. We hope that things go well and we can 'buy-in' and purchase the practice. The problems don't really show up for a couple of years, kind of when the honeymoon is over. When you have spent a few years in a practice, have a good patient following and are doing well it might be that you realize this isn't the office that you want to spend the rest of your career in. Staff, equipment, location, and other factors come into play after a year or two that you did not notice before.

Starting a new office after working for a couple of years does seem tempting. It can be expensive, but so can remodeling a twenty year old office with no digital infrastructure. Depending on where you plan to practice and what type of practice you want to have are two main factors. If you were to go to a suburban area with a dentist every couple of professional buildings it may be a tough sell to start a 'new' practice. We all know that the average dentist is a 55 year old, or older, white male. If you look in the dental journals and your local dental society mailing you will see a lot of practices for sale. It will only increase in the coming years as more dentists near retirement or are unable to keep their practice going at the pace they did 10 years ago. Many say that it is going to be a buyers market in the coming years for dental practices. Plus, don't worry about the loans or financing. Dentists have one of the lowest rates of business failure and banks love us. (which can get you into trouble if you over extend)

That said, I do think one needs to learn the clinical and business sides before you become your own boss. Try to learn from your employer, ask a lot of questions and let them mentor you on being a good business owner and dentist. I would be weary of a potential employer dentist that didn't want to mentor or teach their young associate the tricks of the trade. It only makes them look better, to their patients and staff, and helps you learn from their years of practice (ie. the good and the bad).

Additionally, in terms of owning a business, we often forget that the owner dentist employs him or herself as an employee dentist. Bill Gates is Microsoft, we can all agree to that, but he is still an 'employee' of MS. But, when he gets a loan to help the tanking X-Box losses, it is a Microsoft loan, not a personal loan. Same for businesses. Your school debt is personal debt, you pay that every month to Sallie Mae, 30 years or more, just budget for it and it will be ok. When you get a practice loan, it is paid by the business. (Usually a seven to ten year term) Remember the golden rule of self employment - The owner is the last to get the paycheck. Your assistants, supplies, loans etc... all need to be paid before you get the check.

Good luck, don't stress.

Dr. J

 

[jaxdds]

In general, what happens when one graduates dental school? Does the school help with getting a job or is the new grad out on their own?
Also, what are the benefits of being an associate for a few years?

rose786,

Depending on where you want to work and where you go to school are the two biggest factors. If you go to school for example in New York City, where there are at least three schools close by, you would have a good network of faculty and instructors to help you. Now, that being said, in a lot of schools the full time faculty may not be that well connected to the practicing dentists in the area. When you get into clinic and meet teaching faculty that may have a private practice or know potential employers, your chances are better of making a connection.

A lot also depends on your personality and how much time you have to look for a job during your senior year of school. Most students are busy finishing requirements, taking their clinical boards and the national boards, that they push aside the need to look for employment. Personally I did a residency after school so that I could get more clinical experience and have time to find a practice that I would be happy in.

Many young dentists work in group practices or associate with an established dentist to have a mentor, learn the ropes in terms of patient and practice management, and build up their speed. Dental school barely starts the foundation for a successful career, its the early years of practice where you learn what works and what doesn't in terms of restoring teeth and patient care that really counts. You do more in one month of practice than in all of school, so it doesn't take long to expand your skills and clinical knowledge.

Good Luck...

 

[jaxdds]

First of all thanks for your patience in answering all the questions... i will be completing my DDS in 2008. I beleive that a dentist after DDS can perform all prostho endo or pedo etc procedures (if he has training and skills) and claim the same amount of money from insurance companies which is claimed by a PEDODONTIST, ENDODONTIST etc...Can you confirm the same. Also for recent dental graduate how difficult is it to find a JOB and what is the best kind of JOB to get into as the first JOB? Thanks for your reply....

DDSSure,

You are correct in the fact that a general dentist can perform most procedures that any other specialist can do. However, if anything ever goes south with a procedure, you will be held to the same standard that a specialist would be held to. So, this means that your root canals need to be as good as and last as long as an endodontists root canals. Of course you will always have the case that doesn't turn out as expected, but that should not deter one from wanting to do a procedure. Explaining the risks, benefits, and complications to the patient will go along way if something unexpeceted occurs.

As far as reimbursement with insurance goes, it can be very confusing. I will give you two scenarios. If you participate with an insurance company (meaning that you sign a contract with) then you must accept as payment in full what the insurance company deems is appropriate. If your office fee for a crown is $1000 and the insurance contract says all you can accept as payment is $600, the $400 is called a 'write off'. It's invisible money that you must adjust off of the patients account. If you don't particiapate with an insurance company you charge the $1000 and the patient must pay the entire amount. This can get confusing if the patient has insurance that you don't participate with. It is hard to attract these patients but if you are a good Dr. then people will come to see you regardless of insurance.

As far as fees go specialists do generally charge more for procedures but pretty much if they agree to participate with insurance plans as well, then they can expect to have a write off as well. Many specialists in the area in which I practice do not participate so patients have to expect more of a payment for these procedures.

In terms of finding a job and what type is best is a personal question that each of us needs to find out. Some don't find the answer to what type of practice and practicioner they want to be while in school. A first job out of school, in my opinion, should be one that allows for learning and growth within the practice that you are in. You should choose mentors, whether it be your boss or a professor or adivsor from school or residency. Also, you need to take a lot of continuing education and read reputable articles on recent trends and research in dentistry. I have taken over 50hours so far this year, even though I need only 30 every two years for my license in Maryland. A first job should be one that you are comfortable in and have good support. I have heard stories of classmates having jobs where the owner dentist gave them all the molar endo and pedo patiets while keeping all of the crowns and other procedures they like for themselves. Obviously it is hard to tell from an interview, but there are other signs to look for if you are usure of a potential job.

Dr. J

 

[jaxdds]

you had mentioned somone who attends dental school takes out a 200k-300k loan, how long does it take the average dentist to repay this loan?

FutureOMS,

I have a friend that just started his DDS and he calculated that the cost should be around 200K. Most loans are now capped at about 6% or 6.5% interest rates for the term and are not adjustable (that can always change lower) and they are protected from going up unless you default.

If you have $200,000 at 6% for 30 years, as most loans over $100,000 are rated at, you can expect to have a monthly payment of $1200, if you pay extra by $300 a month, you cut off ten years from the term of the loan, assuming no prepayment penalty with your lender. The same loan, at a 20 year term is about $1450/month payment. I tend to go with the longer term and pay extra just in case things become tight you can drop back to the scheduled payment. If you budget for this when are looking for a job and what you need to make, things should be ok.

Just to throw out the numbers, if you had $300,000 in debt at 6% for 30 years, your monthly payment is $1800. It seems daunting but it is manageable, you are entering a great profession where the cost of your education, which may seem high, is worth it in the long run.

Thanks.

 

[jaxdds]

Hi,

I am originally from Maryland but moved out to California for dental school. I just started but I was curious about the transition back east. I understand that I will take the NERB or other state licensure (I will probably take the NERB as I am unsure where exactly I want to live in the greater Washington D.C. metropolitan area). What agencies could I use to help find a job back east once I graduate? Thank you! 🙂

giraffe117,

Around the middle of your fourth year of school would be a good time to start looking for a job, or if you do a residency, the middle of that would be the same equivalent. If you did decide to come back to the DC area to practice, there is the MD state dental association and all of their components that have monthly newsletters listing job opportunities. www.msda.com You could also use job listing websites or a dental placement firm. This often costs you nothing, but the hiring Dr. would pay a fee.

If you know the exact area or county/city you want to work in you could speak to a dentist in that area, especially a specialist. They know most of their referring dentists and may know who would be looking and be a good fit for your personalities. If you know what type of practice you want that would help as well to narrow down your search.

Finally, if you are unsure of where to work or don't have time while in school you could do a residency on the east coast so that you could take interviews and scope out potential areas to practice in during the residency.

Good luck!

 

[jaxdds]

Hi Dr. J.,

I wish to become a dentist and am applying this year. I'd like to ask a question about what difference will my choice of school make, in the long run? Do patients care about which school you go to, and more importantly, would certain school produce less competent dentist than others? In my case, my dentist (who graduated from a well-know research institution in East with high entrance GPA & DAT) has cautioned me against going to one school in the West (known for its clinical training, and has lower average entrance scores), citing that the graduates from the later school are not well trained. It's hard for me to believe, can this be true?

What is your advice on choosing a school?
BFL

BFL,

Thanks for the question and sorry for the delay. Personally, I don't think that it makes a difference what school one attends, but rather what one does in school and right after that makes them a good dentist. Let me try to answer your questions below...


1. what difference will the school make in the long run....

You should do your research during the application process of what the school makeup is, the location, patient pool and the applicant pool. A dental school far from a city or in a upper class area will have a smaller patient pool to draw from, making it hard to find patients, leading to making it hard to get your requirements. In the long run, you'll have enough experience after school, your residency or first job. All schools are accredited by the ADEA, american dental education assoc., and some are acutally on probation and certain specialty programs have lost their accredidation altogether. Be careful if you apply to one of these schools as it may affect your reputation if the school has problems down the road. Most schools are able to fix the problems within a year or two.

2. do patients care which school you went to...

If you go to a state school, such as MD, Illinois, Florida, etc... and you practice in that area or state, there will most likely be many patients that are alums of that undergrad school. This allows a connection or a conversation starter with patients and helps to break the ice. I went to MD for dental but not undergrad, and even though the campuses for dental and undergrad are an hour apart, I can still connect with patients, talk about sports etc... However, less than 10% of patients have asked where I went to dental school. My diploma is on a wall in the office if they happen to notice it, that's fine. Honestly, as long as you are confident and honest most patients will trust you and believe your opinons and clinical judgements. When I first started in practice and the patients knew I was a new associate they would ask me to tell them about my training. More patients were impressed that I had done a residency (Veterans Admin in DC) and an oral surgery rotation with a very respected hospital center (Washington Hospital Center) than where I had gone to school.

3. do certain school produce less competent graduates...

In my residency there were four schools represented by the seven residents. Everyone had different levels of confidence and experience at the beginning. By the end of the residency we had all improved, however there were a few that did not enjoy difficult endo or extractions and stated that they would not perform them in practice. Overall, it matters with personality and your motivation as to whether you will strive to do good, learn from your mistakes and ask questions.

4. east vs. west schools...

I only applied to east coast schools but I am very good friends with a couple of U of P, Pacific, graduates that are the most competent and smartest dentists I know, next to me. One is now an oral surgeon! Even though the program there is a nonstop 36 months, they know their dentistry very well. I work with a pediatric dentist that went to the Univ. of Washington in Seattle and even though we started working at the same time, he is a great mentor and very competent. He did his pedo training on the east coast and it is amazing to see him work with kids and talk to the parents. I was always under the impression that west coast schools were more competitive but there was pressure to finish requirements due to a lack of patients. I don't know if this is still the case. There were several CA residents in my class at MD.

Good luck, do your research on the schools and ask questions!

Dr. J

 

[jaxdds]

When a new dentist decides to become an associate dentist and works for a principal dentist, are they typically considered an employee or an independent contractor (for IRS purposes)? Also, what is a fair percentage of production/collections for an associate dentist?
I have immigrated from Canada and I am in the process of getting licensed/talking to principal dentists - In Canada, most associates are independent contractors and I would say the average compensation is 40% of production. I talked to a dentist here about a postion and someone had told him that 34% would be appropriate and that I would be an employee - to me that seems like pretty poor compensation as you would not get to write off continuing education, equipment, licensing and insurance, etc. I would love to hear what your experience has been with this.

OkanaganDoc,

Good questions to ask. I'll try my best to answer them below.

1. employee or ind. cont. (IC).....

In the US about 95% of associates are employees, not IC. There was a recent ADA survey that I saw in the newsletter that mentioned this. The IC was used in the past so that the employer, or boss, did not have to pay any employment taxes, social security, etc... for the employee dentist. He would give the assoc. a paycheck and they would be responsible for paying the correct taxes to uncle sam. I don't know how confusing the tax system in Canada, but the IRS is a blast here. The IC is used when an associate literally sub-lets the dental chairs from the employer. Meaning that the only thing provided for the associate is physical space to work in. If you are a 'true' IC, in the US, you (or assistants) furnish and clean your own equipment, make your own schedule etc... If your 'boss' provides equipment, assistants etc, then you are an employee. This is a red flag for the IRS and accountants and not recommended. If a potential employer in the states wants you to be an IC, then you need to have an accountant or lawyer make sure everything is legit. The only IC I know of are specialists that come into a general DDS office, do the endo etc... bring their own assistants and instruments and make their own schedule. The practice owner collects the payment and the IC is paid as agreed upon.

2. fair percentage of production and collection, 40% or 35%...

In the US 30% for a starting DDS with room for growth is considered normal. Usually a base salary around $100K is appropriate before you have established numbers. Now, that being said, if you are in a busy practice and can produce $50K plus a month, then 30% of $50K would be better than being in a slow practice and getting 35-40% of $30K per month. You, as the potential employee, need to ask questions to your potential employer about how many new patients they have, what the doctor production is, because total practice production includes hygiene production. Also, do you get the credit for all the work you do? I have some friends that do not get credit for xrays or periodic exams (hygiene checks).
Most situations I know of have a sliding scale of % of collections, the more you do, the more you collect, the more the practice makes and the more you make. Incentives are good as long as you are a hard worker and are ethical.


3. writing off personal expenses, equipement, insucance etc...

If you are an employee then most expenses are tax deductible. Some practice will pay your malpractice insurance because they get a volume discount if you go with the same insurance carrier. Some employers will pay for your license and deduct it from your pay, sort of like a 401K deduction. Most equipment, in my opinion, should be bought by the office, not the associates as the employee. An employer should see any equipment as an investment that will have an immediate return. If you are asking for a laser or cerac machine, and the dentist is hesitant, then I would not undertake that expense. Get an accountant early on in your career.

I hope I was able to answer your questions. The only other advice I could add would be to be careful if you are going to be the 'first' associate with any dentist. Make sure the practice can support you and have room for you. The owner DDS needs to be booked at least 4 weeks out and have a steady hygiene production to support a new associate. Also, about 20 new patients a month would not hurt the situation. Beware if the owner wants to give you all the kids and molar endo and keep all the crown and bridge. These are all things that have happened to close friends.

Good Luck,

Dr. J

 

[jaxdds]

Dr. J,

Can you compare and contrast the business aspect being the sole owner of a practice and being a in a partnership with another dentist. I can see some benefits and drawbacks for both forms of business ownership. Having an experienced opinion on the subject would be really refreshing.

Turnerjo13,

Good questions. Being the sole owner of a practice can have many different scenarios. The practice I work in has a 'sole' owner, even though there are a total of four doctors working. A sole owner can also be a doc who is by himself. The business aspects for both sides are the same, but different. I'll use terms such as group practice and sole practicioner and partnerships.

If you are a sole practicioner, then you are the only dentist in the practice and by default, the owner. If you need to take vacation, sick, or personal time then you must either find a temp. doctor to cover your office or close during those times. If you close the office for a long period of time, you run the risk of losing employess that rely on their income from your business. Many docs end up paying their employess when their offices are closed. Also, you cannot always take care of seeing patients and the business at the same time. That is why many dentists only see patients 3.5 to 4 days per week. It may look deceiving to see the stats that show dentists only work 3-4 days a week. It does not show the stat that the other 1 or 2 days are often spent interviewing job applicants, handling business aspects of the practice, or taking continuing ed. classes.

In a group practice, that is owned by one doctor, their is more flexibility. Obviously, it takes years to get to this point, but when one does they are albe to work a more flexible schedule, take time off without having to worry about closing the office, and manage the practice without having to stop production. If there are two or three doctors in the practice, then the owner can work more when the other doctors are off or on vacation or sick, and vice versa. Having associates decreases office overhead and increases the profitability. Of course the owner will make more, but typically associates in a busy group practice will do better as well. Often business decisions are made by the owner solely. This can sometimes affect the associates in a negative manner. The decision to buy equipment, hire extra staff, or have certain materials in the office are often a singular decision. In some offices the associates have little say but in others it may be more democratic. It all depends on the owners style of management.

In a partnership, which two or more doctors own the practice jointly, the decisions are made, and must be made, jointly. Often, the partners own 50% each of the practice, and they cannot agree on anything. In some cases one will own 60% and the other 40%. This can become a sticking point when the lesser owner wants to change something or has new business ideas. The clinical side is the same as a group practice with a sole owner, but now two owners are in the mix. Handling compensation and salary can be difficult in a partnership, because no two dentists produce the same amount of dentistry. The situations with partnerships that I am aware of compensate the dentists on percentages of production/collection and also involve some form of profit sharing.

Personally, I would like to eventually be the sole owner of a group practice. If I happen to find someone that would make a good partner then I may consider a partnership. But, due to the similar personality traits that many dentists have, then it may not be successful. Overall, the most successful practices that I know of are group practices with a sole owner or a majority owner. Hope that this sheds some light on your questions.

Dr. J

 

[jaxdds]

This past weekend I had the pleasure to attend the Maryland State Dental Association's annual Chesapeake Dental Conference in Baltimore, MD. I was able to take some really good courses on practice management and adhesive dentistry (bonding, resins, etc...).

When one is first starting out in practice it may be enticing to take some courses that deal with fancy 'cosmetic' dentistry, but the one's that are the best are the down to earth 'real world' courses that teach you the basics and how to be a better clinician.

I had the oppotunity to attend the American Academy of Cosmetic Dentistry (AACD) yearly conference for vitrually free during my residency and felt that although informative, was over my current desire and ability of practice.

Many CE seminars have a good slate of courses, however, make sure that your state allows credit for the courses you take. Some are more designed to marketing and business managemtn and are ineligible for course credit for state licenses.

Take advantage of any CE you can while in school for the reduced rate and often free tuition, and as always ask questions!!!

Dr. J

 

[jaxdds]

Best of luck with school and your future. Glad to be here to offer advice. Dentistry is a great profession!

 

[Neuronix]

This thread is closed until an advisor can be found. Would you like to be an advisor for this topic? PM me for details.