Does orthodontics have a future?

[TDOTO]

I'm a D2 who is pursuing an orthodontic residency but lately I've been feeling some anxiety about the future of the orthodontic field. I'm worried that advancing technology is going to make it easier and easier for GP's to take increasingly difficult ortho cases. Is an ortho residency a bad investment at this point?

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[SirBrotherJam]

I think Ortho will be fine. There will always be a desire for straight teeth. Sure more GPs are getting into the field with Invisalign etc., but they are limited with the amount of correction that can be done and have to think about chair time, training assistants, and having the supplies. You will be there to take on the more challenging comprehensive cases and correct when GPs screwed it up/give up. You may not make as much as they once did, but we're still talking really good $$.

 

[bracketbuster68]

People care more and more about their teeth with social media imo. Aligners have made it possible for adults to get straight teeth when their only option otherwise was metal braces. 3D printers will allow docs to print their own aligners and other resin appliances. Ortho has a great future.

 

[011110]

People care more and more about their teeth with social media imo. Aligners have made it possible for adults to get straight teeth when their only option otherwise was metal braces. 3D printers will allow docs to print their own aligners and other resin appliances. Ortho has a great future.

terrible advice. Ortho has an awful future.

 

[bracketbuster68]

terrible advice. Ortho has an awful future.

Yeah, no.

 

[Cold Front]

I'm a D2 who is pursuing an orthodontic residency but lately I've been feeling some anxiety about the future of the orthodontic field. I'm worried that advancing technology is going to make it easier and easier for GP's to take increasingly difficult ortho cases. Is an ortho residency a bad investment at this point?

I know 5-6 orthodontists. I would say from 1-10, 1 being a total “avoid ortho”, 10 being “do anything to get into ortho”, they said about 4 “for a lot of uncertainly” on average, and would re-consider the profession economically - to some extent.

 

[dentistrydmd]

I know 5-6 orthodontists. I would say from 1-10, 1 being a total “avoid ortho”, 10 being “do anything to get into ortho”, they said about 4 “for a lot of uncertainly” on average, and would re-consider the profession economically - to some extent.

Yeah it looks like ortho will get less easy referrals in the long term future with all the new entrants in clear aligners (lower cost of treatment at GP office) and GP’s tackling more complex cases. I think the job will become more challenging and reimbursements will also go down due to more patients wanting clear aligners and less bracketing (higher overhead costs). But there will always be a place for orthodontists just less easy work as in the most recent decades.
The benefits of it being less taxing on your body as in being a GP and being a unique field of its own will still be there.

 

[Pablo Sanchez]

Particularly page 18 and on. Interpret this as you will.

 

[AONLINE]

I know 5-6 orthodontists. I would say from 1-10, 1 being a total “avoid ortho”, 10 being “do anything to get into ortho”, they said about 4 “for a lot of uncertainly” on average, and would re-consider the profession economically - to some extent.

If you ask this question to the GPs you know, I imagine they would say the same thing, wouldn’t they?

 

[Cold Front]

If you ask this question to the GPs you know, I imagine they would say the same thing, wouldn’t they?

Yes. Dentistry in general has become an illusive profession. Most dentists are not super excited about the profession. With time - it’s “meh” enough to get them out of bed and pay their bills (and some more).

I’ve been on the job for 10 yrs, and I would give dentistry 5/10 for the work enjoyment over time, but 10/10 for the financial potential if you’re strictly in it for the business side. After you do 1,000s of endo cases, 10,000s of restorations, 100,000+ exams, you can easily become numb to it.

 

[charlestweed]

Yes. Dentistry in general has become an illusive profession. Most dentists are not super excited about the profession. With time - it’s “meh” enough to get them out of bed and pay their bills (and some more).

I’ve been on the job for 10 yrs, and I would give dentistry 5/10 for the work enjoyment over time, but 10/10 for the financial potential if you’re strictly in it for the business side. After you do 1,000s of endo cases, 10,000s of restorations, 100,000+ exams, you can easily become numb to it.

It’s impossible to find a job that you truly enjoy because it doesn’t exist. Nobody likes to work. Laziness is a nature of human being. Every job requires some responsibilities and takes away some of your personal time and freedom. Nobody wants to lose such freedom. Everyone wants to have a carefree lifestyle (like when they were young children…when their parents paid for everything) and not have to work. As long as the government keeps giving out unemployment money, people continue to stay home and don't search for another job.

A job, that is stable and pays well, is good enough for me. I don’t have to like it. The more I make and the more I save (and invest), the sooner I can quit working. Passive income is the key to a happy retirement.

The Hispanic population continues to grow very rapidly, especially now, when the government allows the immigrants from the southern border to cross freely. Hispanic parents love their children. They will do anything to make sure their children have beautiful straight teeth. Ortho tx cost is a small amount in comparison $10-20k that they spend on their daughters’ quinceanera. At least with ortho tx, they can make monthly payments.

 

[AONLINE]

Yes. Dentistry in general has become an illusive profession. Most dentists are not super excited about the profession. With time - it’s “meh” enough to get them out of bed and pay their bills (and some more).

I’ve been on the job for 10 yrs, and I would give dentistry 5/10 for the work enjoyment over time, but 10/10 for the financial potential if you’re strictly in it for the business side. After you do 1,000s of endo cases, 10,000s of restorations, 100,000+ exams, you can easily become numb to it.

For those that have not even started, sure we can advise them to not go into dentistry. But for the D3’s and D4’s that are already too deep in the game and already invested time and money into this profession, would you tell them to go specialize so they may enjoy their working life a bit more than the general dentists?

 

[yappy]

For those that have not even started, sure we can advise them to not go into dentistry. But for the D3’s and D4’s that are already too deep in the game and already invested time and money into this profession, would you tell them to go specialize so they may enjoy their working life a bit more than the general dentists?

Most practice owners I know rank their job above 5/10. I’ve never heard it quantified but they seem to get a lot of enjoyment and meaning from their job. The people I know who are less satisfied are working for someone else, or at a DSO, with massive debt.
My observation is that there are a lot of people in dentistry whom, for whatever reason, went into a health care field without having much of a desire to work in health care. If the hours, pay, and perceived “chill” primarily attracts you to a career, you’re going to hate it.

 

[2TH MVR]

The profession of "real" specialty orthodontics isn't going anywhere. Has ortho lost some of it's shine. Absolutely. I posted this before. At one time ortho specialists had the MONOPOLY on all areas of teeth straightening. Everything. Easy cases. Hard cases. This is no longer. GPs are doing the easy stuff with aligners. No different than the other specialty treatments. As an ortho specialty .... we are now just like the other specialties in treating mostly the difficult cases ... as it should be. GPs are treating the easy stuff which is just fine.

As soon as ortho became a "commodity" ..... Corp America, DSOs took advantage and offered ortho tx. EVERY office has a name that ends in
........................ Dental and Orthodontics. In most DSO's ..... the ortho dept probably makes most of the revenue. I know that is a fact where I work. Because of this fact ... I make more than double what the GPs make. Probably triple.

Due to DSOs .... there are jobs for orthos everywhere. Our DSO cannot find a qualified ortho to work in Tucson, AZ. They've been looking for months. I've been covering for those offices for the last 3 months. A PERFECT situation for a new grad. 3 very busy locations. Work there PT and open a small private office on the side. Anyone can PM me if you want more details.

Ortho tx is easy and very fulfilling. Well ....it's easy if you know what you are doing. Unfortunately I've seen alot of crap working at this DSO. You know where this crap comes from? Laziness on the part of the orthodontist and thinking that "technology" will do all your work. Technology will not overcome lack of experience and actual hands on treatment from a skilled orthodontist.

I love what I do. I enjoy changing young people's lives every day ... and some older people also. I enjoy watching the changes from the adjustments I've made previously. I GET NO SATISFACTION FROM HANDING OUT SOME ALIGNERS.

Ortho is not going anywhere. There is so much demand. Like @charlestweed said. The Hispanic population is exploding here in the southwest and they desire quality orthodontics. Interestingly .... they want BRACES. Not aligners. Smart patients.

 

[charlestweed]

Technology will not overcome lack of experience and actual hands on treatment from a skilled orthodontist.

I couldn't have said it better myself.

 

[Alpha Centauri]

The Hispanic population continues to grow very rapidly, especially now, when the government allows the immigrants from the southern border to cross freely. Hispanic parents love their children. They will do anything to make sure their children have beautiful straight teeth. Ortho tx cost is a small amount in comparison $10-20k that they spend on their daughters’ quinceanera. At least with ortho tx, they can make monthly payments.

I find the notion that people illegally entering the country are going to be spending tens of thousands of dollars on their daughter's quincinera is highly improbable

 

[charlestweed]

I find the notion that people illegally entering the country are going to be spending tens of thousands of dollars on their daughter's quincinera is highly improbable

Hispanic parents are big spenders. If you have a chance to visit one of the Disney theme parks, you’ll see the ridiculous amount of money that these parents spend for their kids……expensive Disney gifts, Disney hats, Disney toys etc. How are they able to afford pay for all these? They live with extended family members in a tiny apartment/house. The parents, uncles, aunts, cousins who live in the same apartment all have to contribute a tiny portion of their incomes toward the rent payments. We, Asian immigrants, did the same when we first arrived here. Our family of 5 lived in 1 bedroom and a converted garage and we rented out the other 3 bedrooms to 3 different strangers. That’s how my parents, whose combined income was only $20k/year, were able to put all 3 of us in professional schools. They are my heros.

 

[Cold Front]

For those that have not even started, sure we can advise them to not go into dentistry. But for the D3’s and D4’s that are already too deep in the game and already invested time and money into this profession, would you tell them to go specialize so they may enjoy their working life a bit more than the general dentists?

Well, the discussion of “approach with caution” in the dental profession began years ago, at least since the DSO’s started offering lunch and learns at dental schools back in 2000s.

I remember sitting in one of those lunch & learns and asking myself, how and why did the dental schools allowed the wolf get into the hen house? I’m not sure if the schools got paid by DSO’s to recruit naive dental students as early as 3rd yr in school, but I do remember the DSO’s got first dips in the future workforce and were steering dentists away from private practice as what I deemed to be the at a very young age (in their 20’s).

This is the same concept the military uses - by sending recruiters at undergrad campuses around the country with their “do you want to serve your country?”. Well, DSO’s have a huge leverage on the profession today, they totally have a choke-hold on the dental school to “first job” transition and have a sizeable impact on the future of those dentists. They molded those young dentists to see the DSO model synonymous with dentistry. The DSO’s now see themselves as the gate-keepers, that the vast majority of new grads must work at a DSO before they even consider a private practice.

To your question, the best advise I have for a D3 or D4 today is for them to choose something they will enjoy doing for the rest of their life while being financially very conscience of the risks of high student debt and the future economics of general dentistry versus a specialty. I can’t sway someone into something they don’t enjoy doing, but I can tell them that their decisions could have irrevocable consequences.

 

[Cold Front]

My observation is that there are a lot of people in dentistry whom, for whatever reason, went into a health care field without having much of a desire to work in health care. If the hours, pay, and perceived “chill” primarily attracts you to a career, you’re going to hate it.

There should some form of kryptonite to warn pre-dents about the realities of the profession.

Unfortunately the blame falls on; misguided parents who push their kids to become doctors at all cost, or misleading literature and publications that portray dentistry as a golden ticket profession, or society’s perception of dentists as leprechauns with pots of gold. How many times do we see people discussing dentistry with no mention of how expensive it is to become a dentist? It’s like an accountant telling their client their top numbers all the time with no mention of their bottom numbers.

 

[Cold Front]

I find the notion that people illegally entering the country are going to be spending tens of thousands of dollars on their daughter's quincinera is highly improbable

I don’t know about the south, but the Hispanics in the north are not big spenders in dentistry. The northern states are more blue states and big on social services - specially in medicaid & CHIP enrollment.

9 out of the top 10 medicaid states (by coverage) are in the north, which means the Hispanic communities in the north fair better than the southern Hispanics in utilizing Medicaid for their dental services. In my state, medicaid covers ortho for anyone under 21, and pretty much everything else. So there is definitely geographical consumer behavior by Hispanic communities within the US. The southerners are probably more cash paying for their healthcare services, and doesn’t mean the parents are cash strapped or don’t have the means, but it’s the same reason why some states have more lay-aways or payment plans than others - and it’s just how business is done regionally.

There is also far less illegal immigration in the north compared to the south. There is also less mobility in the north, most Hispanics don’t move around like the southerners. The north is more difficult place to live due to cold winters and less diversity. I’m generalizing here through personal observation, but Hispanics like to live close to other Hispanics. My state is 85% white, so Hispanics resides in the urban areas of the state. Compared to Texas or
California - they are scattered across the state, but then again Texas was part of Mexico centuries ago. So the whole illegal immigration is political, which is used as a tool to energize voters. Certain US senator criticized illegal immigration from Mexico, next thing you know - he is vacationing in Mexico with his family.

Illegal Hispanics typically don’t have social security number and will not be seen by most dental offices without an ID. I was an immigrant first couple
of decades of my life, although legal, my parents or
most parents would not dole out thousands of dollars to cover expensive elective treatments. Many wait as an adult to worry about those non-essential decisions later in life. The priority for any immigrant has always been security, food and shelter, teeth will never rank higher than those top essentials. It’s super rare to see wealthy illegal immigrant.

 

[Cold Front]

The Hispanic population is exploding here in the southwest and they desire quality orthodontics. Interestingly .... they want BRACES. Not aligners. Smart patients.

Care to elaborate on this? Why would they choose braces? Are they doing research? Are they apprehensive against aligners for other reasons?

 

[charlestweed]

Illegal Hispanics typically don’t have social security number and will not be seen by most dental offices without an ID. I was an immigrant first couple
of decades of my life, although legal, my parents or
most parents would not dole out thousands of dollars to cover expensive elective treatments. Many wait as an adult to worry about those non-essential decisions later in life. The priority for any immigrant has always been security, food and shelter, teeth will never rank higher than those top essentials. It’s super rare to see wealthy illegal immigrant.

My offices don’t require the patients to provide the SSN, unless they have insurance and want us to bill their insurance.

Shelter is not an issue for them since they live together with their extended family members. Food in America is not very expensive. Therefore, coming up with $100-120 every month to pay for ortho tx shouldn’t be too difficult for them. Hispanic parents love their kids. They want to give their kids what they didn’t had when they were young. In fact, many of their kids actually have better cell phones and laptops than my kids. My son still uses the very first phone (a mid-range Motorola Z2 phone) that I gave him when he was 13. He’s 16 now.

The illegal immigrants are poor now because they have just arrived to this country. Since the topic of this thread is about "the future of ortho"......in 10-15 more years, these illegal immigrant kids will be 20-25 yo. By then they should be able to afford to pay for their own ortho tx.

 

[charlestweed]

Care to elaborate on this? Why would they choose braces? Are they doing research? Are they apprehensive against aligners for other reasons?

Hispanic patients don’t do research. They respect and fully trust their doctors/dentists. They usually go with what their orthodontists recommend for them. And most orthodontists prefer braces over Invisalign because braces give the orthodontists more control of the ortho treatments….better finish and better occlusion. Ortho is both Science and Art. If you are an artist, would you want to create your own artwork with your own hands or would you want a printing company to create one for you?

I love Hispanic patients because they are not like many wealthy patients, who think that they can buy anything with money and disrespect the doctors.

 

[gryffindor]

I think there are plenty of messed up teeth out there that ortho remains a viable specialty. There are still areas of the country where GPs and DSOs have not intercepted every dental and ortho patient possible. If we can continue educating people that they need to choose an orthodontist and what that actually means, patients themselves will turn down being treated by a GP and look for a specialist. Who doesn't want a specialist to treat them for whatever medical or dental issue they have? The good thing about ortho is that we can advertise directly to the public to get the message across.

The tough part has become teaching someone who makes $20/hour enough hand skills to become a talented clinical assistant. Licensing laws for assistants are so onerous where I live, there is a huge shortage. There are three times as many licensed dentists here than licensed assistants. Many dentists all over the country are experiencing the same pains of shortages in trying to find dental hygienists. In my office, I am leaning more on technology to eliminate procedures formerly done by assistants. Without good support staff, it's much harder and stressful for the doctor in every aspect of running the practice.

 

[Cold Front]

My offices don’t require the patients to provide the SSN, unless they have insurance and want us to bill their insurance.

Shelter is not an issue for them since they live together with their extended family members. Food in America is not very expensive. Therefore, coming up with $100-120 every month to pay for ortho tx shouldn’t be too difficult for them. Hispanic parents love their kids. They want to give their kids what they didn’t had when they were young. In fact, many of their kids actually have better cell phones and laptops than my kids. My son still uses the very first phone (a mid-range Motorola Z2 phone) that I gave him when he was 13. He’s 16 now.

The illegal immigrants are poor now because they have just arrived to this country. Since the topic of this thread is about "the future of ortho"......in 10-15 more years, these illegal immigrant kids will be 20-25 yo. By then they should be able to afford to pay for their own ortho tx.

I get it. But you live in the southern part of the US, I live way up north in the Midwest, few hours drive from Canada. I don’t see that high number of illegal Hispanics in my office (no disrespect by the reference). I see a lot of “legal” immigrants from other countries; mostly from Asia, Middle East and Africa. I was born in Africa, so this gave me a huge advantage in a predominantly white state as a dentist. Almost everyone in my state has a SSN, no one will provide service to you (maybe few unique cash based businesses) if you don’t have one. Illegals here live with legal residents, so they are not living by themselves, or move around without a legal person to lean on. We don’t have good public transportation system like bigger states and cities do, so being illegal here is probably not a great place to live. We are in 2 different worlds in the same country.

 

[Cold Front]

I think there are plenty of messed up teeth out there that ortho remains a viable specialty. There are still areas of the country where GPs and DSOs have not intercepted every dental and ortho patient possible. If we can continue educating people that they need to choose an orthodontist and what that actually means, patients themselves will turn down being treated by a GP and look for a specialist. Who doesn't want a specialist to treat them for whatever medical or dental issue they have? The good thing about ortho is that we can advertise directly to the public to get the message across.

The tough part has become teaching someone who makes $20/hour enough hand skills to become a talented clinical assistant. Licensing laws for assistants are so onerous where I live, there is a huge shortage. There are three times as many licensed dentists here than licensed assistants. Many dentists all over the country are experiencing the same pains of shortages in trying to find dental hygienists. In my office, I am leaning more on technology to eliminate procedures formerly done by assistants. Without good support staff, it's much harder and stressful for the doctor in every aspect of running the practice.

For many patients, I don’t think “education” will ever trump the “financial” aspect of their decisions to choose a dental service.

Just yesterday, a female patient in her 20’s asked me about getting a teeth whitening system. When I told her about my office offers a take home system that costs about $200, she replied “I have a friend who does it at her home for $120 - I will go with that”. I pushed back and told her that only dentists are licensed to provide the most effective whitening system, she simply nodded and wasn’t interested in the facts. Obviously, not every patient is like her, but there is a growing market for people who just shop around purely for the cost of a service, and that’s why companies like Smiles Direct Club and DSO’s who advertise DIY ortho service and “free exams and xrays” are growing fast and are currently a publicly traded companies.

 

[futuredebt]

We are in 2 different worlds in the same country.

This is why America is so great.

For many patients, I don’t think “education” will ever trump the “financial” aspect of their decisions to choose a dental service.

I think cold front nails a lot of issues in dentistry and many like to gloss over what he/she has to say. I think ortho is the best specialty but patient preferences are changing. something to be mindful of.

 

[gryffindor]

For many patients, I don’t think “education” will ever trump the “financial” aspect of their decisions to choose a dental service.

Just yesterday, a female patient in her 20’s asked me about getting a teeth whitening system. When I told her about my office offers a take home system that costs about $200, she replied “I have a friend who does it at her home for $120 - I will go with that”. I pushed back and told her that only dentists are licensed to provide the most effective whitening system, she simply nodded and wasn’t interested in the facts. Obviously, not every patient is like her, but there is a growing market for people who just shop around purely for the cost of a service, and that’s why companies like Smiles Direct Club and DSO’s who advertise DIY ortho service and “free exams and xrays” are growing fast and are currently a publicly traded companies.

The OP was concerned about GPs doing more ortho. GPs aren't charging much less or some charge even more to do ortho not at specialist level quality.

The market that shops around has always been around. There are just many more choices for them to grab some low hanging fruit. Such as the friend doing whitening at $120 or the free exam and X-rays at a DSO that isn't offering the deal to be generous. They're looking for their next 4 quads SRp and 18 class I inlays (not all dentists, I know). Somehow DIY ortho is spreading around the narrative that our services are like $40K. I've heard this a few times now in my office. To me this means we haven't done a good job at advertising affordability.

I was very worried when I graduated ortho in 2009 that it was going to be impossible for me to break into any decent areas in my state. I thought every established practice had already cornered the markets so there was not going to be anything leftover for me to do. I didn't really have any business mentorship to know if my fears were true or not. My success has come by basically doing what the others aren't doing and there is a lot of variability in this statement. Obviously study the demographics for where you are trying to go. Do good work, be honest, run on time, spend time getting to know the patients and their families whether they are spending $150 for a retainer or $10K for a complex case (or higher depending on your market). Don't open in a town that already has 5 orthodontists and expect to be busy right away. Follow charlestweed's principles of keeping overhead low when you are starting out with 0 patients.

 

[charlestweed]

I get it. But you live in the southern part of the US, I live way up north in the Midwest, few hours drive from Canada. I don’t see that high number of illegal Hispanics in my office (no disrespect by the reference). I see a lot of “legal” immigrants from other countries; mostly from Asia, Middle East and Africa. I was born in Africa, so this gave me a huge advantage in a predominantly white state as a dentist. Almost everyone in my state has a SSN, no one will provide service to you (maybe few unique cash based businesses) if you don’t have one. Illegals here live with legal residents, so they are not living by themselves, or move around without a legal person to lean on. We don’t have good public transportation system like bigger states and cities do, so being illegal here is probably not a great place to live. We are in 2 different worlds in the same country.

Yeah, we definitely are in 2 different worlds. I don’t think would survive if I set up practice in a predominantly white state like yours. I did my ortho residency in a neighboring state of yours. People in the midwest are super friendly. My program director, part time instructors and patients all treated me very well. I really enjoyed my time there. But I don’t think I have the right skills/personality to attract the patients and to convince the local GPs to refer patients to me if I set up my practice in one of these midwest states.

I think the reason why I enjoy working and don't mind working on the weekends (while many of my colleagues don’t feel so good about their job and think it’s not worth pursuing ortho) is the type of patients that I treat every day. More than 50% of my patients are Hispanic, 25-30% are Asian and less than 10% are White. My patients respect me and look forward to see me every month. I don’t need to sell. I don’t need to advertise. My patients feel that I have a lot more things in common with them than with other doctors. They feel I can relate to them. Another plus about my job is I also get along very well with all my staff. 100% of my staff are Hispanic…and many of them were born here.

 

[Cold Front]

The market that shops around has always been around. There are just many more choices for them to grab some low hanging fruit.

So the intricacies and nuances of this consumer (patient) behavior is a byproduct of a larger national issue. It’s the same reason why a dollar store opens in this country every 4 hours. It’s the same reason why we as a country are heading to a socialism and universal basic income for people who are falling behind financially. I understand this shouldn’t be a reason to question orthodontists and dentists fees, but we are all living in the same country, and what affects a large segment of our society economically will eventually impact the majority of dentists.

It might be difficult to notice from day to day or month to month, but the change of consumer behavior is very noticeable over 5-10 years. Just talk to any orthodontist over 55 how their patients behaved in the 90s compared to the last few years. Just look at what happened over those decades; more than 20M people moved from being uninsured to insured through Obamacare (not sure how many of that number in adults or kids got ortho treatments under Medicaid versus out-of-pocket? I would guess mostly Medicaid?), the poverty guidelines has almost doubled (if a family of 4 made under $15k/yr in 2000 they were considered living in poverty, today it’s now close to $30k/yr - which means the government knows the highest growth in population WAS, IS and WILL BE the poor)... So, it’s a generational and socioeconomic shift in disposable income/finances that had/will have a direct impact on society’s healthcare priorities.

I’m not arguing that ortho is dying or will experience a bleak financial outlook, but I would imagine they would have to go up further upstream on their river to catch their regular salmon in the future.

 

[gryffindor]

So the intricacies and nuances of this consumer (patient) behavior is a byproduct of a larger national issue. It’s the same reason why a dollar store opens in this country every 4 hours. It’s the same reason why we as a country are heading to a socialism and universal basic income for people who are falling behind financially. I understand this shouldn’t be a reason to question orthodontists and dentists fees, but we are all living in the same country, and what affects a large segment of our society economically will eventually impact the majority of dentists.

It might be difficult to notice from day to day or month to month, but the change of consumer behavior is very noticeable over 5-10 years. Just talk to any orthodontist over 55 how their patients behaved in the 90s compared to the last few years. Just look at what happened over those decades; more than 20M people moved from being uninsured to insured through Obamacare (not sure how many of that number in adults or kids got ortho treatments under Medicaid versus out-of-pocket? I would guess mostly Medicaid?), the poverty guidelines has almost doubled (if a family of 4 made under $15k/yr in 2000 they were considered living in poverty, today it’s now close to $30k/yr - which means the government knows the highest growth in population WAS, IS and WILL BE the poor)... So, it’s a generational and socioeconomic shift in disposable income/finances that had/will have a direct impact on society’s healthcare priorities.

I’m not arguing that ortho is dying or will experience a bleak financial outlook, but I would imagine they would have to go up further upstream on their river to catch their regular salmon in the future.

I don't doubt the economy is shifting, but the poor D2 just wanted an outlook on ortho and if the GPs were going to take over. At the end of the day, orthodontics is mostly a cosmetic service. If someone desires it, they will find a way to get it. You brought up Medicaid. Medicaid in some states covers zero ortho. In other states such as mine, they only cover severe cases but with an age limit, usually 17 or 19. I just looked it up, 1 out of every 3 kids in my state is on Medicaid. If the parent wants ortho treatment for their kid and it gets denied for Medicaid, they will have to scrape together at least $3500 around here (not my practice). I don't ask how patients find the money but if they want to do it, they do. Some of the Obamacare plans are really great; if they do cover an ortho case, they pay really well. Some are total garbage too, they claim to cover stuff but good luck ever getting a human to approve anything and I've tried. No, it's not necessarily like the environment the age 55+ doctors graduated into, but almost nothing in our daily lives is the same as it was 20 years ago.

The large corporations in the US are hell bent on reducing the middle class, I get it. I don't want to get into a long nuanced discussion about US economics. Yes it does affect dentistry/ortho but we will have to adapt unless one chooses to move to another country I guess. Not sure what country that would be, people still beat down all doors trying to come here.

 

[yappy]

Please do not base your career decisions on SDN economic forecasting.

 

[Cold Front]

I don't ask how patients find the money but if they want to do it, they do.

Savings. Then again, people buy $1,800 cell phones, $2,000 TV’s and $4,000 apparels. Dentistry/Ortho fees are not far from those alleys.

As far as the OP, anything he/she reads on SDN should be taken with a grain of salt. Not every poster knows what they are talking about, or can speak outside dentistry objectively.

 

[gryffindor]

I know 5-6 orthodontists. I would say from 1-10, 1 being a total “avoid ortho”, 10 being “do anything to get into ortho”, they said about 4 “for a lot of uncertainly” on average, and would re-consider the profession economically - to some extent.

Can you give some more insight on why they feel this way? I'd like to think SDN is a good resource for pre-dents to research their careers. Better than going out there and talking to a bunch of age 55+ orthos back near your hometown who paint a rosy picture of how great the career is and has no idea today's residents are graduating with $600K+ in debt. Those doctors might have had only $60K in debt, if that.

For the past 5 years, I have hired residents in my office to work under my supervision (they all have their state dental licenses). The last 2 lucked out into full time positions in private practice. The others are also all employed. I still think if you're willing to join the 6 days/week club and do the beans & rice routine for a while, one can pay down the debts faster and then elevate himself/herself into being more choosy of their practice options.

 

[011110]

Can you give some more insight on why they feel this way? I'd like to think SDN is a good resource for pre-dents to research their careers. Better than going out there and talking to a bunch of age 55+ orthos back near your hometown who paint a rosy picture of how great the career is and has no idea today's residents are graduating with $600K+ in debt. Those doctors might have had only $60K in debt, if that.

For the past 5 years, I have hired residents in my office to work under my supervision (they all have their state dental licenses). The last 2 lucked out into full time positions in private practice. The others are also all employed. I still think if you're willing to join the 6 days/week club and do the beans & rice routine for a while, one can pay down the debts faster and then elevate himself/herself into being more choosy of their practice options.

I recently talked to 4 orthos that were looking to leave the profession.

 

[2TH MVR]

My patients respect me and are looking forward to see me every month. I don’t need to sell. I don’t need to advertise. My patients feel that I have a lot more things in common with them than with other doctors. They feel I can relate to them.

Your affordability probably helps also. Right?

I’m not arguing that ortho is dying or will experience a bleak financial outlook, but I would imagine they would have to go up further upstream on their river to catch their regular salmon in the future.

Nice analogy. Yes. Depending on where (urban vs. rural) an ortho decides to practice ..... they will have to practice dictated by the dental economics of that region.

Can you give some more insight on why they feel this way? I'd like to think SDN is a good resource for pre-dents to research their careers. Better than going out there and talking to a bunch of age 55+ orthos back near your hometown who paint a rosy picture of how great the career is and has no idea today's residents are graduating with $600K+ in debt. Those doctors might have had only $60K in debt, if that.

Yes. I think SDN is a good resource. I belong to that 55+ ortho group. The thing is .... they have seen 1st hand how the delivery and economics of orthodontics has changed. Especially in the urban, saturated desirable cities. Sure. Some of those 55+ have had perfect, ideal careers, but I'm pretty sure most of them have experienced some economic downturn towards the end of their careers. It's inevitable. We all hit a peak in our income producing years and then .... there is the eventual decline. For most of us. Not everyone.

And yes. You are correct. Most of us on SDN make up a very small representation of practicing dentists. We are aware of the pitfalls of excessive DS tuition. I've played golf with dental instructors for MidWestern Arizona. Most of them are totally unaware of how expensive their place of employment is ..... or it's impact on future dentists. I give them grief all the time for being part of an unsustainable DS debt for these new dentists.

From where I'm sitting .... the field of ortho is doing fine. It has changed, but there are new opportunities. More employment opportunities now than when I first started out.

 

[2TH MVR]

I recently talked to 4 orthos that were looking to leave the profession.

And did you happen to talk to the 1000s of orthos that love their field?

 

[gryffindor]

I recently talked to 4 orthos that were looking to leave the profession.

So I ask you the same question as I asked the other poster, please give a little more detail on why they felt this way. Or else just throwing statements around like this helps no one.

Leave and do what? I looked into leaving as well. Not because I hated ortho, but because I became disabled. Leaving is easy. Finding something that will pay as well as clinical dentistry or ortho on an immediate basis and with flexibility is very, very hard.

 

[011110]

So I ask you the same question as I asked the other poster, please give a little more detail on why they felt this way. Or else just throwing statements around like this helps no one.

Leave and do what? I looked into leaving as well. Not because I hated ortho, but because I became disabled. Leaving is easy, finding something that will pay as well as clinical dentistry or ortho on an immediate basis and with flexibility is very, very hard.

They said the prospects for full time employment aren’t that good for the amount of debt you have to take on. Too many negatives market wise that is a long time to actually get a return of your investment.

 

[mmc12]

They said the prospects for full time employment aren’t that good for the amount of debt you have to take on. Too many negatives market wise that is a long time to actually get a return of your investment.

So what are they doing instead? Retiring? Becoming GPs again? Going into another specialty? Getting out of dentistry?

 

[gryffindor]

They said the prospects for full time employment aren’t that good for the amount of debt you have to take on. Too many negatives market wise that is a long time to actually get a return of your investment.

They're not wrong. If they thought they were going to get hired full time then no, I don't think that is the reality for most new ortho grads. Our profession, dental and ortho, has done a terrible job of taking care of our new grads. It's partly why the chains made the inroads they did over the last 20 years which 2TH MVR has also mentioned. There is work out there, but the chances of landing a full time associateship in a technologically advanced practice in a nice wealthy suburb back home with well trained staff is low. You may have to commute further or a lot further, take on jobs in GP offices with no ortho support staff, work at the chains and endure whatever drama that comes with that environment, work undesirable days and hours (the vast majority of appointments in ortho happen after 2 pm, Saturday and Sundays are very popular days in some markets), etc. to piece together a full time schedule. I get it, lots of ortho residents turn up their noses if told they have to endure this kind of schedule. To slave away in order to graduate at the top of your class and match at a "good" residency and then find out all that's out there are a bunch of mostly terrible associateships seems like an insult to the hardwork you put in and the loans you took to call yourself a real orthodontist. If you graduate at the top of your medical or law class, you get hired by hospital systems and law firms with a 6 figure paycheck and fancy lobbies with fancy coffee and nice benefit packages. That doesn't exist for us or if it does, it's rare and it's not being offered to newbie grads.

The big ortho money comes from owning your practice and calling the shots. And even that is a long road.

 

[011110]

They're not wrong. If they thought they were going to get hired full time then no, I don't think that is the reality for most new ortho grads. Our profession, dental and ortho, has done a terrible job of taking care of our new grads. It's partly why the chains made the inroads they did over the last 20 years which 2TH MVR has also mentioned. There is work out there, but the chances of landing a full time associateship in a technologically advanced practice in a nice wealthy suburb back home with well trained staff is low. You may have to commute further or a lot further, take on jobs in GP offices with no ortho support staff, work at the chains and endure whatever drama that comes with that environment, work undesirable days and hours (the vast majority of appointments in ortho happen after 2 pm, Saturday and Sundays are very popular days in some markets), etc. to piece together a full time schedule. I get it, lots of ortho residents turn up their noses if told they have to endure this kind of schedule. To slave away in order to graduate at the top of your class and match at a "good" residency and then find out all that's out there are a bunch of mostly terrible associateships seems like an insult to the hardwork you put in and the loans you took to call yourself a real orthodontist. If you graduate at the top of your medical or law class, you get hired by hospital systems and law firms with a 6 figure paycheck and fancy lobbies with fancy coffee and nice benefit packages. That doesn't exist for us or if it does, it's rare and it's not being offered to newbie grads.

The big ortho money comes from owning your practice and calling the shots. And even that is a long road.

Yea the lack of full time employment and the ability for a chain to cut days without impunity. The problem one said with owning was they had started a scratch and still only have enough patients for one day a week.

 

[Cold Front]

Can you give some more insight on why they feel this way?.

For different reasons; constant staffing issues, running a practice headaches, encroaching DSO offices and general direction of the profession.

They were also upset they didn’t get the second round of PPP stimulus and HHS provider relief funds, because the ortho offices account receivables are monthly ACH payments debited from patients accounts, compared to GP offices which are day to day transactions. So on paper, the government didn’t deem ortho offices as not severely impacted by the covid lockdowns. So they missed out on $100’s of thousands in those different funds each.

Ortho is still a good gig, but overtime, I’m seeing less love for it from younger orthodontists. I guess I could get into underlying issues by tying it to other factors. But it will be all Greek to SDNers.

 

[charlestweed]

Yea the lack of full time employment and the ability for a chain to cut days without impunity.

Compare to other specialties, ortho usually gets the most work days at one location. My wife is also a specialist. For her to fill her 6 days/wk work schedule, she used to travel to 9 different offices. I only have to travel to 6 offices. At one of the corp offices, where I work at, ortho has 6 days/month. The OS only works 2 days/month. Endo and perio each works 1 day/month. I don’t know about other states. But here in CA, the specialists have to travel to multiple offices if they want to work full time.

The problem one said with owning was they had started a scratch and still only have enough patients for one day a week.

There’s no reason to work more than 1 day per week (and waste a lot of money on staff salaries and electric bills) when you can book as many as 80-100 patients in a day. With 400 active patients (which is a healthy number for an ortho office), you only need to work 1 day a week. That’s why a lot of orthodontists own more than 1 office.

 

[gryffindor]

Ortho is still a good gig, but overtime, I’m seeing less love for it from younger orthodontists. I guess I could get into underlying issues by tying it to other factors. But it will be all Greek to SDNers.

This and another statement you made in post #33 sound like you're insulting those of us who are out in private practice and still bother to post here hoping to help lost dental students.

For different reasons; constant staffing issues, running a practice headaches, encroaching DSO offices and general direction of the profession.

They were also upset they didn’t get the second round of PPP stimulus and HHS provider relief funds, because the ortho offices account receivables are monthly ACH payments debited from patients accounts, compared to GP offices which are day to day transactions. So on paper, the government didn’t deem ortho offices as not severely impacted by the covid lockdowns. So they missed out on $100’s of thousands in those different funds each.

ACH is only one part of accounts receivable. There are also insurance payments and down payments from new consults. If their collections didn't drop during March - June last year, then they were far ahead of the pack. Some practices were only closed for April and maybe a little bit of May since the guidelines varied so much from state to state. Some of those practice kept starts going in April by doing virtual consults and collecting down payments that way. So if they didn't see the drop in collections that qualifies one for these programs, that would imply they were doing well financially. These might just be the doctors who are pining for the days of ortho where you hung your shingle and were the only office for the closest 50K people and printed large buckets of money.

I haven't applied yet for round 2 of PPP but I did receive 2 rounds of HHS. I don't remember the rules exactly to financially qualify for HHS payments. A lot of people missed out on the deadline for the second round of payments for dentists from HHS and cried sour grapes.

I don't disagree with constant staff issues. I face those as a growing practice and they suck. I already wrote above that running a practice is the only way to make the big ortho money, so anyone getting into this field thinking they're going to take home Wall Street finance-level money without doing the ugly stuff is mistaken. Ugly stuff for me includes updating a tons of stuff inside my practice management software because as we've grown, the things I sent up in the software 5 years ago need to be tweaked and improved. Or filing a worker's comp claim because an employee got hurt while making a retainer. Getting busier at the office and trying to add more days, but juggling childcare since the busiest appointments are between 2 & 6. And it goes on and on.

 

[charlestweed]

Your affordability probably helps also. Right?

Of course! Who doesn’t want to pay less for beautiful straight teeth? Everyone is happy. My patients are happy because of the significant amount money they save for choosing my office. I am happy because my patients trust me and let me do my job…. and not interrupting me with a bunch of nonsense demands and questions. My assistants are happy because they are employed.

 

[Cold Front]

This and another statement you made in post #33 sound like you're insulting those of us who are out in private practice and still bother to post here hoping to help lost dental students.

Ha! If I wanted to throw a shade at anyone who owns a practice, I would be more specific with my posts. Yes, a lot of people post a lot of scant opinions. I once did too... so if I point it out, I’m insulting or targeting private practice owners? It’s insulting to even suggest that. Dentists are well known to be full of ego, sensitive and many consider themselves as criticism-proof. We are all on the same team, so let’s not make the issues with the profession about ourselves - we could use to learn from each other, practice owners or not.

 

[Cold Front]

Nice analogy. Yes. Depending on where (urban vs. rural) an ortho decides to practice ..... they will have to practice dictated by the dental economics of that region.

Yes. I think SDN is a good resource. I belong to that 55+ ortho group. The thing is .... they have seen 1st hand how the delivery and economics of orthodontics has changed. Especially in the urban, saturated desirable cities. Sure. Some of those 55+ have had perfect, ideal careers.

The grass was greener in dentistry few decades ago, but it’s still a viable career with more challenges and complexities. I think today’s young dentists need to have more problem solving skills to adapt to the new challenges and uncertainties. Just look at the SDN topics from 10 years+ ago, the whole tempo has changed.

 

[gryffindor]

Ha! If I wanted to throw a shade at anyone who owns a practice, I would be more specific with my posts. Yes, a lot of people post a lot of scant opinions. I once did too... so if I point it out, I’m insulting or targeting private practice owners? It’s insulting to even suggest that. Dentists are well known to be full of ego, sensitive and many consider themselves as criticism-proof. We are all on the same team, so let’s not make the issues with the profession about ourselves - we could use to learn from each other, practice owners or not.

So if you're not throwing shade, then please explain your statement below. What exactly are the underlying issues that are Greek for the orthodontists on this SDN thread? Maybe most dental students won't understand the global economic issues tying into dental/ortho in general. Forget pre-dents, they're being sold a hopeless bill of goods if they're getting out of DS with $600K+ debt. I understand market forces etc. but I'm not in a position to change much besides exposing young docs to realities out there. And even then I won't change too many minds. But it's still good for us to post them because for those who do want to read our posts and do some google research about trends and economics, they can make smarter decisions than their classmates who will all be trying to get crappy jobs in all the same saturated cities.

I guess I could get into underlying issues by tying it to other factors. But it will be all Greek to SDNers.

 

[Cold Front]

So if you're not throwing shade, then please explain your statement below. What exactly are the underlying issues that are Greek for the orthodontists on this SDN thread? Maybe most dental students won't understand the global economic issues tying into dental/ortho in general. Forget pre-dents, they're being sold a hopeless bill of goods if they're getting out of DS with $600K+ debt. I understand market forces etc. but I'm not in a position to change much besides exposing young docs to realities out there. And even then I won't change too many minds. But it's still good for us to post them because for those who do want to read our posts and do some google research about trends and economics, they can make smarter decisions than their classmates who will all be trying to get crappy jobs in all the same saturated cities.

Read post #33 again. There is no mention of the word “orthodontists” in there. It was intended to not expand on the topic to someone who may not understand it. We’re preaching to the choir here, we both agree that DS cost has become a ridiculous barrier to enter the profession and will unfortunately lead to a deep personal finances consequences if the trend continues.