Does orthodontics have a future?

[gryffindor]

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.

Yeah, I don't think I want my kids going into clinical dentistry even if I can help them avoid the debt. We've given up way too much control and it's much harder to make the big bucks. Still possible, but way more BS now.

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[2TH MVR]

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.

You know. I haven't always agreed with @charlestweed , but I'm starting to see we have the same view points.

Maybe its because we both practice in severely saturated markets (LA and Phx). Maybe it's because we both work for the dark side (DSOs). All I know from my last 4 yrs working in a DSO is that there is PLENTY of work available. I started out PT (2-3 days per week). That turned into 3-4 days per week. Now I am at 5 days a week. If I wanted .... the DSO would gladly give me 6 days a week (which I did when I was covering in Tucson ...thankfully over). I had two other DSO's looking to hire me (Gentle Dentle and Somos Dental) if I ever left my current employer. Is the work glamerous? No. Do I get paid well enough. YES. Is the travel (I currently travel to 6 locations all 45-60 minutes each way) a hassle? Not for me. I enjoy the change in scenery. Quite frankly my past private practice locations were around the same commute.

Maybe @charlestweed is right. Are the new grads just too picky? Or as @gryffindor posted ..... new ortho grads after all their hard work expected an easier path to private practice. I've got news for all you new ortho grads. It wasn't easy for myself when I graduated in the early 90's. There were NO EASY CORP jobs around. My 1st job was a failed associateship. Then I went out and BOUGHT myself a job. Partnership leading to buyout.

Do I like Corps/DSO's? Not at all. I wish they were never around. But the fact is .... they are here to stay. The problem, as I see it, as a private practice associate .... there will always be this jealousy towards the owner. This owner right in front of you driving his Italian or German sportscar (no electric cars .... sorry Charles ) is making money off of you. I have no real boss in Corp. An invisible owner. No micro managing. Nothing. If you show up. Do your job (ortho starts). Everything is easy.

If I were a new ortho grad. Get a job at a DSO. Contact @charlestweed and learn how to start a scratch practice with the least amount of investment or find a reasonably priced smaller ortho practice to buy. Be diversified. Corp and PP. If your PP takes off ... then quit the Corp job. One of the younger orthos that worked for our DSO did this. Worked for the Corp for 6-7 years and started a couple of PP on the side. His PP grew and he quit his Corp job. Good for him.

There's plenty of job opportunities.

 

[Cold Front]

Yeah, I don't think I want my kids going into clinical dentistry even if I can help them avoid the debt. We've given up way too much control and it's much harder to make the big bucks. Still possible, but way more BS now.

That statement is a sign of the times. At least you are aware and understand it. I will post a thread about this year’s cost of attendance at USC soon... $155k+ first year alone, yet, people are fighting over that program. Their 3 yrs ortho - first year cost of attendance is about that high too. We are no where close to seeing the end of this insanity. A $1M+ in student loans/money spent to become a specialist has finally become the norm at many institutions.

 

[Cold Front]

The problem, as I see it, as a private practice associate .... there will always be this jealousy towards the owner. This owner right in front of you driving his Italian or German sportscar (no electric cars .... sorry Charles ) is making money off of you. I have no real boss in Corp. An invisible owner.

I think the invisible owner is worse, because I would consider that as me as an associate not even be worthy to be close to him or her.

Kind of like working for Elon Musk or Jeff Bezos, but you work at the local facility. Which is cool, but you are dealing with their minions for all decisions instead.

DSO’s can be taken advantage of, and I think you are example of that. You have worked in private practice and as an owner before, so you are just working for them for your own personal gains.

 

[gryffindor]

Do I like Corps/DSO's? Not at all. I wish they were never around. But the fact is .... they are here to stay. The problem, as I see it, as a private practice associate .... there will always be this jealousy towards the owner. This owner right in front of you driving his Italian or German sportscar (no electric cars .... sorry Charles ) is making money off of you. I have no real boss in Corp. An invisible owner. No micro managing. Nothing. If you show up. Do your job (ortho starts). Everything is easy.

This is lame if an associate is jealous. I remember being a fresh general dentist out of my GPR and working the unglamorous jobs. My first thought after a few weeks was "there is no difference between the practice owner and me. I need to do my own thing after I get out of ortho residency. Being an associate sucks."

My associate and I drive the same exact car, hers is newer LOL.

That statement is a sign of the times. At least you are aware and understand it. I will post a thread about this year’s cost of attendance at USC soon... $155k+ first year alone, yet, people are fighting over that program. Their 3 yrs ortho - first year cost of attendance is about that high too. We are no where close to seeing the end of this insanity. A $1M+ in student loans/money spent to become a specialist has finally become the norm at many institutions.

When I applied in 2005, USC ortho was going to cost me $270K for 3 years of tuition and housing. It was the most expensive ortho program out there but I told myself I was ready to take on the debt to become an ortho. I didn't get invited to interview so I never got to join the 6 days/week club to pay that off.

 

[Teeth and Titanite]

Approximately what size of city would be a good place for an orthodontist to set up shop? approx. 80,000 - 100,000 people? Smaller?
Of course, thats not the only factor and one would have to determine the level of competition and what not. I'm just trying to figure out what sort of town would allow a new orthodontist avoid issues of saturation.

Also, for the orthodontists in this thread: how scared should pre-dents looking into orthodontics be about schools like Georgia School of Orthodontics and their huge class sizes? Are there more orthodontists graduating than there is demand?

 

[2TH MVR]

Approximately what size of city would be a good place for an orthodontist to set up shop? approx. 80,000 - 100,000 people? Smaller?
Of course, thats not the only factor and one would have to determine the level of competition and what not. I'm just trying to figure out what sort of town would allow a new orthodontist avoid issues of saturation.

Also, for the orthodontists in this thread: how scared should pre-dents looking into orthodontics be about schools like Georgia School of Orthodontics and their huge class sizes? Are there more orthodontists graduating than there is demand?

Deciding where you want to live and work is complicated. Are you married? Do you have a family? Are you concerned with the quality of the schools? Do you desire a city with culture? It's give and take. If you go to areas where there is less competition .... well .... there is a reason no one wants to live and work there. It probably sucks. If you are single .... want to get ahead with your DS debt ..... you have more options. My wife and I do not like crowded, noisy city centers. We chose to live in a beautiful small city (N. Scottsdale) that is relatively close to where I have to work. At the end of the day .... you work to LIVE. Right?

If the city is too small .... you may need to have other locations. This was popular even in the early 90's. With large cities .... more competition (other orthos, DSO,s, GPs and Pedo doing ortho, etc. etc. But there are more opportunities for FT or PT work.

As for Georgia school. Of course I do not like it. Just watering down the applicant pool. My ortho program accepted FOUR residents. Four highly accomplished, diserving residents. When you are 1 of 4 ....it felt special. Huge class sizes sounds like a trade school. A For Profit school instead of a learning institution. I'm sure the Corps like it.

 

[2TH MVR]

This is lame if an associate is jealous. I remember being a fresh general dentist out of my GPR and working the unglamorous jobs. My first thought after a few weeks was "there is no difference between the practice owner and me. I need to do my own thing after I get out of ortho residency. Being an associate sucks."

My associate and I drive the same exact car, hers is newer LOL.

Agree that it is lame. But did any of us go to DS/Ortho res to become an employee? Early on it's fine, but with every passing year .... a younger dentist/ortho probably feels that they are missing the boat. Wasting time. Coulda ... shoulda .... leading to regret.

Most of us have egos. My situation was different, but there was NO WAY I was going to work for another dentist, ortho, pedo, etc. Childish? Probably. My wife refers to me as a man-child lol.

On a different topic, but are the ortho practices maintaining their values as the older doc approaches retirement? You said it yourself that too many older orthos wait too long. If it's a good practice in a good area with few Corps, orthos, etc ..... then maybe that is a good fit for an associate working towards a future buyout.

Again .... back to the OP. Ortho is fine. Tons of need. Patients desire ortho because they can SEE their crooked front teeth. GPs have the hardest job. Selling dentistry such as deep cleanings, S&RP, perio issues, nonsymptomatic caries, nonvital teeth needing RCT, etc etc. All things that a patient CANNOT see or feel. Talk about trust issues.

As with any area of dentistry: GP, pedo, perio, etc. Don't go to an expensive school and then expect that your title of "ORTHODONTIST" will automatically bail you out. Choose ortho because you like ortho.

 

[gryffindor]

Agree that it is lame. But did any of us go to DS/Ortho res to become an employee? Early on it's fine, but with every passing year .... a younger dentist/ortho probably feels that they are missing the boat. Wasting time. Coulda ... shoulda .... leading to regret.

Most of us have egos. My situation was different, but there was NO WAY I was going to work for another dentist, ortho, pedo, etc. Childish? Probably. My wife refers to me as a man-child lol.

Any dentist or orthodontist or any dental specialist can start a practice immediately after you receive your state dental license. When I was in dental school, we were sold the narrative of "work for a few years in an associateship where you are mentored by an older doctor, then look for ownership." That worked out for some people, not all. I don't remember there ever being any discussions of how to start a practice from scratch or buying something right when you graduate dental school. In my ortho residency, the idea of starting from scratch as soon as you graduate was accepted as normal. From what I read, the residents today are not necessarily being encouraged to go this route. Maybe the thought of taking on more debt is overwhelming. Maybe the residents don't want to work as hard on the non-clinical stuff as a business owner and really just expect to show up, treatment plan and do clinical procedures and then go home promptly at 5.

It is scary to open the doors and have 0 income. But it is the only way to truly be the boss of it all.

As far as the older doc selling a declining practice, it will only be a good fit for an associate to buy out if the older doc lets go of the reins. A declining practice isn't going to have enough money to pay both doctors unless the older one leaves. Too many don't want to leave and in comes the frustration for the younger doctor again. I think this is all from a lack of our business education. We can't be emotionally invested in the practice and refuse to let it go. Micromanaging an associate makes the associate frustrated for sure. Then you also have to have something attractive to sell to a younger buyer and if you let the practice decline, what are you really selling them anyways?

 

[2TH MVR]

Any dentist or orthodontist or any dental specialist can start a practice immediately after you receive your state dental license. When I was in dental school, we were sold the narrative of "work for a few years in an associateship where you are mentored by an older doctor, then look for ownership." That worked out for some people, not all. I don't remember there ever being any discussions of how to start a practice from scratch or buying something right when you graduate dental school. In my ortho residency, the idea of starting from scratch as soon as you graduate was accepted as normal. From what I read, the residents today are not necessarily being encouraged to go this route. Maybe the thought of taking on more debt is overwhelming. Maybe the residents don't want to work as hard on the non-clinical stuff as a business owner and really just expect to show up, treatment plan and do clinical procedures and then go home promptly at 5.

It is scary to open the doors and have 0 income. But it is the only way to truly be the boss of it all.

As far as the older doc selling a declining practice, it will only be a good fit for an associate to buy out if the older doc lets go of the reins. A declining practice isn't going to have enough money to pay both doctors unless the older one leaves. Too many don't want to leave and in comes the frustration for the younger doctor again. I think this is all from a lack of our business education. We can't be emotionally invested in the practice and refuse to let it go. Micromanaging an associate makes the associate frustrated for sure. Then you also have to have something attractive to sell to a younger buyer and if you let the practice decline, what are you really selling them anyways?

It's all personality. When I graduated ..... my singular goal was practice ownership. I had no intention of working for another ortho. My 1st associateship was actually a 6 month associateship leading to the purchase of that practice. Towards the end of the 6 months the negotiations broke down and I left. I was essentially unemployed for the next 6 months. No Corps around for me to get an easy job. Then I discussed a partnership with an older ortho. Set terms. 18 month partnership. At the end of the 18 months .... I bought him out for a pre-determined price. All was good. Started a scratch office a few yrs later. Then another one with real estate.. Opening offices from scratch is easy when you already have income from your other locations. btw: that 18 month partnership was invaluable in teaching me the business side of ortho.

As for selling. You have to decide. Do you sell when your practice is actually worth something. Or hire an associate and deal with a situation where your practice may not be busy enough for 2 docs. Or simply continue practicing with eventual declining revenue as you get older and a practice that will be worth nothing.

 

[Cold Front]

You have to decide. Do you sell when your practice is actually worth something. Or hire an associate and deal with a situation where your practice may not be busy enough for 2 docs. Or simply continue practicing with eventual declining revenue as you get older and a practice that will be worth nothing.

This is the same dilemma when it comes to retiring and withdrawing social security. Do you retire early at 62 and get 5/9 of your regular full retirement benefits at age 66? The benefits are further reduced to 5/12 if it exceeds 36 months of the early retirement phase. If you start receiving retirement benefits at age 67 or beyond (until age 70), you'll get 108 percent of the full monthly benefit each year you delay retirement.

Personally, the best option for an owner dentist to retire is to keep their office running as long as they can - either through an associate or hygiene only program like I intend to. Hygienists in my state can work 3 weeks without a dentist supervision. I can pop into the office once every 3 weeks and cherry pick couple of buccal pit restorations and refer everything out (hoping the referral doesn’t steal my hygiene patients haha). Then go back to retirement until my next visit in 3 weeks. This is assuming I still own my building and have 0 rent due.

 

[charlestweed]

This is the same dilemma when it comes to retiring and withdrawing social security. Do you retire early at 62 and get 5/9 of your regular full retirement benefits at age 66? The benefits are further reduced to 5/12 if it exceeds 36 months of the early retirement phase. If you start receiving retirement benefits at age 67 or beyond (until age 70), you'll get 108 percent of the full monthly benefit each year you delay retirement.

Personally, the best option for an owner dentist to retire is to keep their office running as long as they can - either through an associate or hygiene only program like I intend to. Hygienists in my state can work 3 weeks without a dentist supervision. I can pop into the office once every 3 weeks and cherry pick couple of buccal pit restorations and refer everything out (hoping the referral doesn’t steal my hygiene patients haha). Then go back to retirement until my next visit in 3 weeks. This is assuming I still own my building and have 0 rent due.

I've never thought about living on the social security money. It will be too little for me to retire comfortably.

I don’t think I can completely retire from my job. I plan to work until my body no longer allows me to do so. A lack of responsibility, carefree attitude, unlimited leisure may sound fun for a year or two. I’d go crazy if I stay home doing nothing every day….getting out of bed late, watching TV, eating and getting fat etc. I don’t like golf. Gardening is too hot. I can’t just travel 365 days/year. I already experienced this boredom when I had to stay home for 2 months during the Covid shutdown last year.

Work gives me some mental benefits such as the feeling of contribution and being appreciated, the satisfaction of solving problems and learning new things, the relationship I have with others (staff and patients) etc. And with the daily work schedule, I don’t have to keep asking myself the same question “what to do next?” I think this is why so many of my colleagues continue to work in their 70s and 80s. This is why some practicing dentists (as well as other specialists) want to go back to school to specialize in ortho. Practicing ortho is fun…it’s perfect for old people.

 

[Cold Front]

I've never thought about living on the social security money. It will be too little for me to retire comfortably.

Neither do I. However, we pay into the program and could be insolvent by the time we retire.

I would not factor out its $5k/month in retirement income if it’s still around when I qualify for it. Every $1 counts when most people retire, specially when you’ve been paying into the program for decades.