Dentistry start-up questions...

[Pre-Dent1]

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Sorry for posting what is essentially a "pre-dental" question in the dental forum (and if a moderator feels it's too out of place, they're free to move it obviously), but this question is one which I'm having a difficult time finding info about, and I figured that that the folks in this forum might have answers, seeing as how you're either practicing dentists or dental students. Okay, here goes:


What, exactly, does the general "process" of starting a career in dentistry include for new graduates? For instance, I've heard that most new graduates do some sort of associate work under a practicing dentist for a few years in order to gain experience. My questions regarding this are:


1) Is this standard practice?

2) Is it recommended or absolutely necessary in your estimation?

3) Is this work generally paid, and if so, what is the general range of pay (I'm in NYC, for reference)?

4) Is this the common course of events for specialists and general dentists alike, or is one more likely to have to "assist" for longer (or at all)?

5) How many years does this usually continue for? Is it until the new dentist feels sufficiently confident in his patient-care skills, or is it until they save up enough dough to purchase or open up their own practice? Which leads me to my next set of queries...


Regarding opening up your own practice, either alone or with a partner/group:


1) How does this process generally work? I've heard that one can purchase a practice from a retiring dentist. Is that how it's commonly done, or can people start their own practice and build up their own clientele? Which is more common in your opinion?


2) Obviously, the price of practices being sold varies along with practice size and revenue, but what is the general range, and how is the "purchase" handled? Is it like any other purchase (e.g., a home?)-- that is, are loans taken out from the bank to cover the cost, and then repaid over a period of X years (I assume this is the case)?


3) For those of you (if there are any) who have started your own practice (rather than purchasing an existing practice), how long did it take to build a decent clientele? For those who have purchased one, did many/most of the patients stay with the practice after purchase?


4) On average, how long would you say it takes a new dentist to start making an income in excess of $90K from the time of graduation? If you're a specialist, how long from the time of completion of your specialty training until you are making more than $110K (since from what I gather, specialists earn more on average)?


I apologize for the amount of questions I've asked, and, of course, no one is under any obligation to answer all (or any) of them. If you only feel like answering a specific question, that would still be appreciated. Basically, I just want a sense of what life is like for the new dentist and how the career generally unfolds post-grad. Also, please understand that the reason I've asked many questions about time (e.g., "how many years do I have to X") and money is only because I'm an older student who would like to start a family sometime before I'm 40. 😛


Any help would be appreciated, and I'd appreciate it if the mods would leave this in this forum, since most pre-dents (and counselors etc.) I've encountered have not been too helpful in answering these sorts of questions. Thanks in advance, all. 🙂

 

[burton117]

Try posting this question on Dentaltown.. They have practicing dentists who may be able to answer your question in addition to the dental students here on this forum..

Dentaltown Login Page

http://forums.studentdoctor.net/showpost.php?p=1391816&postcount=6

 

[12YearOldKid]

There aren't any hard and fast answers to these questions, but I'll take a shot.

1-5. Yes, most dentists associate for a little while. It is not required by law, but it's a good idea for most people. Most people I know are getting ~$80-110k as associates. Some are making more and some less; it really depends on your skill, speed and how busy the practice is since associates are usually paid a percentage of what they produce.

Some people associate their entire careers but most only work for somebody else 1-5 years before getting their own practice.

1-4. It is more common to buy a practice from an existing dentist. This way you get a well-trained staff who can run many of the business systems without a lot of input from you. You get used but adequate equipment. But most of all you get a patient base who (hopefully) will continue coming to the practice --this means making money your first month.

Starting from scratch can be a good idea if there is a real need for a dentist in the area. If you have to compete with existing offices for patients you can plan on not making a profit for the first several months. Many people do this but it is not for the weak of heart.

There are brokers and lenders out there who specialize in dental offices and can help you with financing whether you start from scratch or buy existing. The cost of the practice becomes part of your office overhead and is repaid like any other loan over several years.




Money is a funny topic to discuss in dentistry. There are guys making $200k one year out of school and guys who have been at this for years and years who are still hovering around the $100,000 mark. A lot will depend on your location (does your area need another dentist?), your business sense, and your ability to inspire confidence / avoid hurting your patients.

But most will be making more than $110,000 after their first couple years.

 

[WildcatDMD]

What, exactly, does the general "process" of starting a career in dentistry include for new graduates? For instance, I've heard that most new graduates do some sort of associate work under a practicing dentist for a few years in order to gain experience. My questions regarding this are:


1) Is this standard practice?

2) Is it recommended or absolutely necessary in your estimation?

3) Is this work generally paid, and if so, what is the general range of pay (I'm in NYC, for reference)?

4) Is this the common course of events for specialists and general dentists alike, or is one more likely to have to "assist" for longer (or at all)?

5) How many years does this usually continue for? Is it until the new dentist feels sufficiently confident in his patient-care skills, or is it until they save up enough dough to purchase or open up their own practice? Which leads me to my next set of queries...

I would also highly recommend visiting www.dentaltown.com for just about anything you could possibly want to know about associateships, or even dentistry in general.

It sounds from your post that you may be a little confused about what an associateship means in dentistry. It is basically just one dentist (the associate) working as an employee to another dentist who owns the practice. You are not "assisting", you are just practicing dentistry--although I have heard of a lot of situations where the associate will not always get the biggest cases that come into the office.

You usually get paid a percentage of either your production (how much is billed for your procedures/month) or by a percentage of collections (how much money is collected for your procedures by the office). I have seen % ranges from 25-35% discussed in the dentaltown forums. Many associate contracts also include a base pay of about $400/day.. so if your percentage of production is lower than that number, you get that base pay (whichever is higher). As already stated, this works out to anywhere from 80k to 200k/yr depending on the practice and the skills of the associate. Usually on the lower end just out of school.

I know of a few dentists that plan to practice as employed associates for their entire career. You never have to deal with owning the business, but you also are always an employee.

Just about every general dentist associates for a couple years to get the experience, speed, practice management skills, and overall "know-how" to buy-into or purchase a practice (I don't know how it works for specialists). Often the practice the associate buys is that of the dentist they work for who had been planning retirement. In this case, the two dentists can transition the practice with a buy out.

As for the 90k for general dentists and 110k for specialists:
I would say it is not at all unlikely to make over 90k your first or second year out of school for a general dentist.
If I am not mistaken (I'm not looking to specialize) just about ANY specialist should make well over 110k first year out of residency.

 

[Pre-Dent1]

I'd like to thank everyone above for their responses, particularly 12YearOldKid and WildcatDMD-- it's much appreciated. 🙂 I'm also going to check out that Dentaltown forum, burton117. Thanks for the link.


I knew that the "associateship" wasn't an apprenticeship, but rather actual independent work, by and large, but I didn't realize that one's pay was usually tied to production; so that info is much appreciated as well. A couple of questions arise from the info you gentlemen have provided:


1) You say that the associate typically purchases the practice of the dentist they've been working with upon their retirement. But how does one go about finding (and becoming associates with) dentists who plan on retiring in, say, 2-5 years? Are there listings anywhere? (I assume that the listings of practices being sold in, say, the NY Times and other periodicals are not offers for "associateship," but rather just outright purchase, correct?) Or is it just through word of mouth or connections made during dental school?


2) I assume that these income figures you guys are quoting are post-expense/overhead but pre-tax and personal expenses (such as health insurance etc.), correct?


Again, thanks in advance-- I truly appreciate it. 👍 I obviously don't expect this to be a huge thread, but a couple of more responses would be welcome, just to get a larger variety of responses so as to better draw conclusions (not that I don't trust you guys or anything 😛). Any specialist info in particular would be most appreciated (since Wildcat and 12YearOldKid answered most of my questions for general practice). Ciao for now. 😎 🙂


EDIT: And if anyone else cared to answer and feels that their answers would roughly mirror the responses above, feel free to simply post "I concur." 😛

 

[Dr. Pedo]

I'm specializing in pediatrics-----I can only talk about what I've witnessed and personally have seen----Majority of pedo grads in mid-west/south east are starting out for 175,000 as an associate. Two friends one started at 165,000 plus commission and the other 210,000 flat. Some are much higher esp. in Georgia----where majority are starting assoc. out for 260,000 plus. Just depends on where you want to live. We find ppl looking for assoc. through our director at the grad program, alumni, and networking with those out in the field.

I know many in the mid-west start their own pedo practices. Couple grads that started their own 3 years ago are do very very well. Bigger risk, bigger reward. For peds though you have to be able to deal with the type of production level necessary for success. Smaller fees/ more kids kind of thing. Very fast pace and at time high stress.

As an older student you may not want to spend an additional 2-3 year specializing so this might not be for you. However, I started dschool at 28 so it depends what old is

Dr.B

 

[12YearOldKid]

I'm specializing in pediatrics-----I can only talk about what I've witnessed and personally have seen----Majority of pedo grads in mid-west/south east are starting out for 175,000 as an associate. Two friends one started at 165,000 plus commission and the other 210,000 flat. Some are much higher esp. in Georgia----where majority are starting assoc. out for 260,000 plus.

Dr.B

Holy crap!$$$!

 

[Pre-Dent1]

I'm specializing in pediatrics-----I can only talk about what I've witnessed and personally have seen----Majority of pedo grads in mid-west/south east are starting out for 175,000 as an associate. Two friends one started at 165,000 plus commission and the other 210,000 flat. Some are much higher esp. in Georgia----where majority are starting assoc. out for 260,000 plus. Just depends on where you want to live. We find ppl looking for assoc. through our director at the grad program, alumni, and networking with those out in the field.

I know many in the mid-west start their own pedo practices. Couple grads that started their own 3 years ago are do very very well. Bigger risk, bigger reward. For peds though you have to be able to deal with the type of production level necessary for success. Smaller fees/ more kids kind of thing. Very fast pace and at time high stress.

As an older student you may not want to spend an additional 2-3 year specializing so this might not be for you. However, I started dschool at 28 so it depends what old is

Dr.B

Thanks for the info on the peds specialty. I would be starting dental school at 29, so I guess we're both old fogies. 😛 Peds is actually a specialty I was considering, since I adore children. What the average work-week like for an associate or private practice pediatric dentist? More than 45 hours/week or less? I guess you could always scale it based on your income needs, anyway (I don't imagine myself needing $250K, though I'd like some free time to be able to pursue my true love, which is writing 🙂 ).

Thanks again. 👍

 

[gryffindor]

Going rates for newbie grads in NYC looking to be employed and make money to pay rent:

8 hour work day -

$400/day for general dentist
$600/day for pedo

Interesting to note that around here - $50/hour general dentist, $35 - 37/hour hygienist

The potential to earn more than these minimums do exist if you are being paid on percent production/collection.

Of course, I just got a call today for an office in Port Jervis (Orange County) offering $75/hour for a general dentist. But it is Orange County, not easily commutable from NYC without a car. Keeping a car in NYC would probably quickly eat the difference in the $25/hour, so it would probably be a wash. So it all depends on where you want to be.

 

[Dr. Pedo]

Peds is a whole different ballgame.
Speed and numbers are truly the norm. You are seeing roughly 20+ children a day, that's very conservative! The ability to work quickly is essential and having very good hand-skills certainly doesn't hurt. You are obviously working with referrals and well........doctors' don't refer their best kids, ya know 😀 .

Liking kids is great and obviously essential but please take time to shadow or really get involved with ped dentistry. Liking kids is just not enough to get people into peds. In fact, many of my friends love kids and that is EXACTLY why they couldn't do peds. It takes truly a special personality to deal with the fustrations of a difficult child-----being deaf comes to mind 😛 . But being able to be stern and behavior manage a child through voice control etc... is sometimes too much for some. They would rather not deal with the whole....parents and child team.

For instance I had a child referred from guess what......a pediatric dentist 😱 for behavioral problems. Child comes in, has developmental problems along with ADHD and a 3 cavities. Child is 7 and immediately starts to scream once in chair. Blurting four-letter words, trying to bite us...etc... Dad is chairside as I attempt voice control and restraint, dad feels I'm too aggressive, I give rules to kid, dad doesn't have rules at home, kid doesn't listen to me...Dad is asked to wait in waiting room, now two issues happening, Dad finally leaves, I set the rules, kid cries through appt. Dad peeks around the corner every 3 mins..well you get the picture. But those cavities are filled

Also seeing children during dental school is not always a very good cross-section of what you'll see in private practice or as a grad student.

Peds includes special needs as well. I treat profound and severly disabled patients. Many are non-communicative, combative, etc... There are individuals with severe head injuries, 3 years olds going through chemotherapy with no immune systems and kids who have disease processes you have to look up in order to understand. Many need general anesthesia but some simply can't be put through that type of procedure. A lot of this is referred to rodeo dentistry because you really need to go with the flow and not get frustrated. However, they are some of the most incredible individuals I'll ever meet and the parents are some of the most appreciative people I know. They understand our challenge and we are the only ones truly qualified to take on such cases or should I say willing to take on such cases.

So is there money in peds? Definitely. But with anyone making good money there is a reason------this is challenging work and you have to have your pedal on the gas at all times. Now not all kids are as much work! I had a 3 yr. old today that didn't move, opened her mouth, took bitewings, put some GI on a couple anteriors and gave me a hug at the end------this is why I love my career choice. Most pedo doc work 4 days a week, avg 20-35 pt. a day, 50% or more employee 6 or more people, and work 1/2 a day in the OR doing general anesthesia perhaps 2x-3x a month. Plus some----- actually most are on call several times a month----but that depends.

PM with any specific questions,
Dr. B

 

[aphistis]

Peds is a whole different ballgame.
Speed and numbers are truly the norm. You are seeing roughly 20+ children a day, that's very conservative! The ability to work quickly is essential and having very good hand-skills certainly doesn't hurt. You are obviously working with referrals and well........doctors' don't refer their best kids, ya know 😀 .

Liking kids is great and obviously essential but please take time to shadow or really get involved with ped dentistry. Liking kids is just not enough to get people into peds. In fact, many of my friends love kids and that is EXACTLY why they couldn't do peds. It takes truly a special personality to deal with the fustrations of a difficult child-----being deaf comes to mind 😛 . But being able to be stern and behavior manage a child through voice control etc... is sometimes too much for some. They would rather not deal with the whole....parents and child team.

For instance I had a child referred from guess what......a pediatric dentist 😱 for behavioral problems. Child comes in, has developmental problems along with ADHD and a 3 cavities. Child is 7 and immediately starts to scream once in chair. Blurting four-letter words, trying to bite us...etc... Dad is chairside as I attempt voice control and restraint, dad feels I'm too aggressive, I give rules to kid, dad doesn't have rules at home, kid doesn't listen to me...Dad is asked to wait in waiting room, now two issues happening, Dad finally leaves, I set the rules, kid cries through appt. Dad peeks around the corner every 3 mins..well you get the picture. But those cavities are filled

Also seeing children during dental school is not always a very good cross-section of what you'll see in private practice or as a grad student.

Peds includes special needs as well. I treat profound and severly disabled patients. Many are non-communicative, combative, etc... There are individuals with severe head injuries, 3 years olds going through chemotherapy with no immune systems and kids who have disease processes you have to look up in order to understand. Many need general anesthesia but some simply can't be put through that type of procedure. A lot of this is referred to rodeo dentistry because you really need to go with the flow and not get frustrated. However, they are some of the most incredible individuals I'll ever meet and the parents are some of the most appreciative people I know. They understand our challenge and we are the only ones truly qualified to take on such cases or should I say willing to take on such cases.

So is there money in peds? Definitely. But with anyone making good money there is a reason------this is challenging work and you have to have your pedal on the gas at all times. Now not all kids are as much work! I had a 3 yr. old today that didn't move, opened her mouth, took bitewings, put some GI on a couple anteriors and gave me a hug at the end------this is why I love my career choice. Most pedo doc work 4 days a week, avg 20-35 pt. a day, 50% or more employee 6 or more people, and work 1/2 a day in the OR doing general anesthesia perhaps 2x-3x a month. Plus some----- actually most are on call several times a month----but that depends.

PM with any specific questions,
Dr. B

Ugh. Thank God for people like you--and I mean that sincerely. It's thanks to folks like you that I'll have the luxury of dividing my pedo patients into "good kids" and "referrals." 😉 👍

 

[rocknightmare]

Peds is a whole different ballgame.
Speed and numbers are truly the norm. You are seeing roughly 20+ children a day, that's very conservative! The ability to work quickly is essential and having very good hand-skills certainly doesn't hurt. You are obviously working with referrals and well........doctors' don't refer their best kids, ya know 😀 .

Liking kids is great and obviously essential but please take time to shadow or really get involved with ped dentistry. Liking kids is just not enough to get people into peds. In fact, many of my friends love kids and that is EXACTLY why they couldn't do peds. It takes truly a special personality to deal with the fustrations of a difficult child-----being deaf comes to mind 😛 . But being able to be stern and behavior manage a child through voice control etc... is sometimes too much for some. They would rather not deal with the whole....parents and child team.

For instance I had a child referred from guess what......a pediatric dentist 😱 for behavioral problems. Child comes in, has developmental problems along with ADHD and a 3 cavities. Child is 7 and immediately starts to scream once in chair. Blurting four-letter words, trying to bite us...etc... Dad is chairside as I attempt voice control and restraint, dad feels I'm too aggressive, I give rules to kid, dad doesn't have rules at home, kid doesn't listen to me...Dad is asked to wait in waiting room, now two issues happening, Dad finally leaves, I set the rules, kid cries through appt. Dad peeks around the corner every 3 mins..well you get the picture. But those cavities are filled

Also seeing children during dental school is not always a very good cross-section of what you'll see in private practice or as a grad student.

Peds includes special needs as well. I treat profound and severly disabled patients. Many are non-communicative, combative, etc... There are individuals with severe head injuries, 3 years olds going through chemotherapy with no immune systems and kids who have disease processes you have to look up in order to understand. Many need general anesthesia but some simply can't be put through that type of procedure. A lot of this is referred to rodeo dentistry because you really need to go with the flow and not get frustrated. However, they are some of the most incredible individuals I'll ever meet and the parents are some of the most appreciative people I know. They understand our challenge and we are the only ones truly qualified to take on such cases or should I say willing to take on such cases.

So is there money in peds? Definitely. But with anyone making good money there is a reason------this is challenging work and you have to have your pedal on the gas at all times. Now not all kids are as much work! I had a 3 yr. old today that didn't move, opened her mouth, took bitewings, put some GI on a couple anteriors and gave me a hug at the end------this is why I love my career choice. Most pedo doc work 4 days a week, avg 20-35 pt. a day, 50% or more employee 6 or more people, and work 1/2 a day in the OR doing general anesthesia perhaps 2x-3x a month. Plus some----- actually most are on call several times a month----but that depends.

PM with any specific questions,
Dr. B

will i be able to send adults to you 😉