So - I'd like to begin by first saying that this is a throwaway, because I don't really feel like having any of you discover who I am - (never underestimate the power of the internet. Dentistry is a very “front” facing profession. Your mug will be plastered on the website of whatever office you decide to work at.) Because of this, I will try to keep personal details to a min.
What has compelled me to go back to SDN, and write what appears to be a memoir? I’m fed up with the field, and everything it stands for. My brother is EM physician (just finished his residency a few years back), and I am pretty sure I'm able to see both sides.
So, young‘uns - 1st - SDN has a reputation for being all doom and gloom. A “sky is falling mentality” I guess. Can’t say I chuckled when I first started going through threads several years back during dental school. But now as a graduate, and practicing dentist… its funny how things work out. The field is saturated, and due to market forces we, as dentists can’t really control, it is definitely headed in a downwards trajectory. Don’t say I didn’t warn you guys.
I graduated roughly 5 years ago. I came out with several hundred thousand dollars of debt. I didn’t think too much about paying them off - I figured I’d just start associating and the rest would take care of itself.
I’m making good progress on it - but my issues with dentistry lie not so much with the debt (although thats a huge part - especially nowadays. Other people have covered this - so I’m not going to delve into it too much), but other issues with the field most people wouldn’t think about if they were applying today.
1) SATURATION. I kid you not - Dentistry is headed towards a zero sum race to the bottom.
There really are too many dentists. Straight up - the field is headed the way of pharmacy. Dental chains are buying out every retiring dentist, and squeezing out completion. On the surface - you’re like “oh - well the ADA says that we’re facing a shortage of dentists! They NEED me!” No. Stop. If you actually think this, go back and apply to medical school, where residency spots are tied to funding, and can’t be multiplied 2x at a whim. I have friends who graduated in my class who are still stuck with 90k associating gigs.
I firmly believe that the issue is mainly because 1) Too many grads with too many loans are flooding the marketplace, and more importantly - 2) Older dentists ARE NOT RETIRING. This is HUGE. If you go back to 2001-2002, people were saying that dentistry would be facing a shortage, that there wouldn’t be enough docs to make sure little Timmy’s tooth decay wouldn’t go unchecked.
The numbers of dentists needed today per 100,000 people are less than what was needed two decades ago. Dentists today are more efficient, have broader training, and are capable of doing more (no more referring everything out - new docs are now doing extractions, Invisalign, you name it). But older docs aren’t retiring. What happens is a “semi-retirement” where the doc comes in 1 day a week, still owns the office, etc, and the poor associate is only making ~90k a year (60k after taxes, and 30k after repaying loans. I’m not kidding). This all resulted in a huge increase in the # of dentists, especially after the financial crisis. According to a recent ADA survey - 1/3 of dentists AREN’T busy enough! This is huge! In addition, the number of dentists has continued to go up EACH year, after the ADA said there was a shortage back in ~2005
2) The debt isn’t quite worth it anymore. I graduated 5 years back, and I thought my debt was a lot. For everyone intending to go 300-500k in debt, you realize thats 30k+ in interest every year? Paying pack 4k a month out of every paycheck? For what its worth - you’re making ~90k when you start. The way the field is now, a GPR is basically essential.
You realize you’re in school ONLY 2 years less than an EM physician? And they get paid ~330k when they start working. 2 extra years, and you quadruple your salary? I firmly believe anyone who is in dental school could easily have gone to med school, even if you need to do a postbacc - it’s within range. Strictly financially, Medicine has FAR more to offer.
3) You feel like a used car salesman with all the competition.
If you’re an introverted person, or are not comfortable “coaxing” people to accept procedures they might not otherwise, drop out of the field right now. This isn’t even corporate - its you trying to keep your office afloat/trying to pay your student loans. Yes, that patient 50/50 could have a crown or no, but if YOU don’t do it, another dentist down the street IS going to do it, and pocket the $2000 themselves.
Back in the day (think 80’s) if a tooth didn’t hurt/bug the patient, the dentist left it alone. Nowadays, with every one and their mom is trying to sell each patient a full mouth reconstruction (as well as offering massages and other bull**** remedies) is it no wonder people don’t take dentists seriously? No joke, the office down the street from me is a “Dental Spa” that offers a full range a skin rejuvenations, massages, and other girly/try-hard stuff I’ll have to ask my wife about because I don’t know what any of it is
4) Backbreaking work. No joke it’s only been five years, and my lower back is killing me very day. My hands hurt, and my shoulders feel like they're made of stone. Add in the fact I'm looking at mouths all day - the novelty has worn off.
5) The job itself leaves much to be desired. You clean/fix teeth. Thats it. You don’t do complex jaw surgeries (no, Mr. Oral Surgeon - you don’t. You pull 3rds all day in private practice pretending you're a doctor) and you definitely don’t do anything reconstructive asides from teeth. You’re a glorified tooth mechanic. Now don’t get me wrong - I love what I do - but there are other things that now, after several years of practice, I feel like I would also derive pleasure from doing.
6) Insurance companies will f****** gut you and leave you to die on the street. Reimbursements are going down . You might ask — “why does this affect me? I’m going to run a FFS practice!” It affects you because FFS is only viable in certain areas - Anywhere from 0% (lol you wish) to 80% of your payer mix will be PPO. Delta Dental is the bane of my existence and basically a monopoly in several places -
they provide dental insurance coverage for 1/3 of the adults in the United States. This monopoly is FEDERALLY protected - meaning there’s no competition for dental benefits/price. The McCarran–Ferguson Act (
http://healthcarereform.procon.org/view.answers.php?questionID=001890) basically allows this. I can’t drop them because 40% of my patients have their insurance, and last year when they decided to cut fees in my area by 5%, I got screwed to the tune of 70-80k in lost income. This leads me to my next point…
7) Dentistry is influenced by market trends/the squeezing of the middle class. The middle class is getting squeezed. Now this definitely affects you, because 20+ years ago, many, many more jobs were unionized, more people had dental insurance, and more people took the time to see the dentist. Average family income (adjusted for inflation) hasn’t risen in a decade! Things like raising the minimum wage, for example, will actually HELP dentists because it makes the average person more likely to afford/see a dentist. But the way it is now, the average family is poorer than they were 10 years ago, and this translates to less than 50% of us adults actually having dental insurance and an even smaller amount using it.
8) Other minor things - such as running an office, insurance write-offs, dealing with people in general, and lack of respect among EVERYONE (the latter being a pretty small issue, as least for me - but I know how neurotic everyone is on SDN, so this might be something to keep in mind)
Now - all this might seems sort of convoluted. I’m typing this right now after a particularly frustering day at my office. I can see how this profession might have worked a decade or two ago. But I swear to god - I’m not sure if the next 10 years are going to be very much fun for anyone. I have zero bargaining power with insurance companies. Incomes have stagnated - and as a new dentist, you can expect maybe 90k-120k or so - and you’ll be stuck at that level for 2-5+ years. The real kicker is the saturation though. All the rest, most people can deal with. But when 4+ offices go bankrupt in my suburb every year - I’m starting to realize that the field is cracking. Incomes are slowly decreasing - I expect within 5 years or so average starting salary for an associate will be in the 80-100k range (it already is in a lot of places)
For all the people who think I’m some sort of SDN troll - heres a QA section for ya:
Q. You sound mad - well, I’ll have you know- I’m going to be a super dentist! I’ll be the one to buck trends and pay off my 400k loans in 5 years! Just watch me!
A. Ok, Jimmy, good luck. With 400k in loans, no bank is going to loan you money to even purchase a practice. You’ll be making 90k for the next 7 years. You can moonlight as a doctor while in residency and make more than that
Q. Why did you even go into Dentistry if you hate it?
A. I still like dentistry - it’s just that the field is dying, or at least, headed towards a huge “market correction” and I can see it clearly from my vantage point. I feel like a pharmacist circa 2000 making 120k, and life was good. Fast forward 10 years…
Q. Where are you pulling that figure from - 90k as a starting salary of a dentist? Every survey I see says 140k.
A. Those salary surveys are compounded over years and years - meaning they still have data from 2005 when associates used to be paid $500+ a day and 35%+ of production. That doesn’t exist anymore. Today, you can expect to make 90k to 120k if you want to live anywhere within 100 miles of a major city. And if you say that you won’t - you’re lying. This is EVERYONE. Don’t lie to yourself and say you want to live in an oilfield in North Dakota. You guys are what - 19-20 years old in the forum? Do you guys understand that at 27/28/29, when you graduate/finish your residency, you’ll be thinking of getting married. Getting settled down, having a wife and kids - and trust me, your wife won’t want to wake up and chase moose off your property.
Q. Where do you see dentistry in 10 years?
A. At the same level as pharmacists, job opportunity wise. Salaries will continue to drop, and the dentist/population ratio will skyrocket leading to declining income (Hell, my income dropped ~30k as an owner the past two years.) If there isn’t a dentist in every Walmart by then, well color me surprised (KIDDING - most will probably be in strip malls, to be honest). Loans will render most graduates unable to purchase practices because they’ll be owned by chains, and most dentists will just be employees making peanuts for their education (look at pharmacy - the other field that doesn't have mandatory residencies/where it's easy to open up a school)
Q. You mentioned your brother was an EM physician. Is how does he view things in the healthcare field right now?
A. First and foremost, I should state my brother doesn't give a f*** about dentists. As in - while Dentists (even the predents in this forum) have this insecurity complex about not being "real doctors", the number of times "dentist" crosses my brothers mind is laughably small. When was the last time you thought about an optometrist? When you needed new glasses 3 years back, otherwise you forget they exist. Thats how 90% of people view dentists
Now for the meat. My brother makes (slightly adjusted) around 320k gross income right now. His first contract out of fellowship was for around 275k. I make around 160k as an owner. 2 years back, I was at 190k, but Delta Dental decided to cut my reimbursement, and now I'm working twice as hard to woo patients to get their teeth taken care of so they don't show up in front of my brother in the ER because of an abscess. I don't give massages or have a spa at my practice, so another few points docked for me.
Physicians like to moan and groan about how the government is out to get them, their pay will be docked, etc. But the fact is - it's not going to happen - at least anytime. The AMA is extremely powerful, and there are well over 1 million physicians in the United States. Supply and Demand doesn't even play a role, because the number of residency spots is governed by government funding levels (which hasn't risen in a decade), and thanks to political gridlock, probably wont rise for the 20 years.
Dentists - all you need is a new school, and suddenly over a 10 year period, you have 1500 new dentists in one geographical area.... all trying to sell you a massage along with your prophy...
My final word to you all? Do anything else. Trust me. Don't say I didn't warn you.
Signed,
-A Current Dentist
PS. I'm posting this here because I realize many of you are too young and don't/are unable to frequent DentalTown. I'm simply keeping guys in the loop. I would have appreciated it if someone did for me back in the day when I was applying - I'm just passing it forward.
