Endo or Perio...

[IHeartEndo]

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Hey, all.

I recently finished a GPR, and am about to begin private practice (as a GP) in a week. I enjoy both endo and perio procedures. I did a fair amount of perio sx (flap sx, cr lengthening and implants) and endo sx (including apicos). If I could hear some comments from both endodontists and periodontists in private practice to see how things are in the real world, I would appreciate it. (I'm thinking of specializing).
i.e. pros/cons, stresses of private practice, how much you enjoy what you do, future of each, and profitablity.

Thanks

 

[servitup]

Where did you do your GPR? Sounds like a good one.

 

[armorshell]

If you're doing all of that righ tnow, why waste you time specializing?

 

[charlestweed]

15 years ago, when implants weren’t as popular as they are today, endodontics was a one of the most desired specialties in our class. 3 of my 4 roommates (they were also my classmates) are endodontists and my wife is a periodontist. They all told me that they were glad that they specialized and that they don’t have practice as GPs.

Endo:

The hours are not as flexible as other specialties. You have to be at your office all day (even when you don’t have any patient or only 1-2 patients on the schedule) to receive “emergency” phone calls from the referring GPs. If you are not available to do the emergency RCT, the GPs will send their patients to another local endodontist who has better office hours than yours.

To get more patients, many endodontists have to accept HMO plans. Since the GP don’t get paid much for doing RCT on the HMO patients (ie $80-100 a case), they find excuses not to do the RCT and refer these HMO patients to the endodontists. HMOs pay the endodontists a lot more but it is still very low compared to the UCR fee.

Perio:

Flexible hours. You only have to be at your office when you have patients. On the days you don’t have patients, you can supplement your income by working as an in-house periodontist at different GP offices. When my wife is not at her private office, she goes to 7 different GP offices. On certain days, my wife works at 1 GP office in the morning and at another GP office in the afternoon. On some slow days, my wife brought our 2 kids to work, placed 1-2 implants in an hour, and took the kids to Disneyland afterward🙂.

The problem with perio is many GPs ignore perio diseases and don’t refer patients to the periodontists. By the time the cases reach my wife’s office, the teeth are pretty much hopeless….they need extractions and implant placements. You can’t survive if you just sit there and expect the GPs send patients to you. To do well, you have to be good at both implant placements and restorations. For many GPs who don’t have strong clinical skills, you have to help diagnose and tx plan implant cases for them. You have to come to their offices and show them how to make provisional restorations after implant placements, restore implants, and adjust the final restoration etc. Once the GPs know how to restore implants, they will continue to refer patients to you.

Good luck with your decision.

 

[drhobie7]

Do endo. You can have the best of both worlds and place implants too! Hehehe.

 

[charlestweed]

Endodontists can place implants…..only if the GPs let them.

 

[Stroszeck]

The BIGGEST mistake, i think, that endodontists made was not accepting and embracing implants early on. If you really think about it, it makes perfect sense ultimately for an endodontist to be the primary specialist to place implants - you send a pt in for a consult, if they can't save the tooth via RCT they can pop it out and put an implant in. Unfortunately due to stubborness on their part to avoid embracing that important technology, now you have OMS and Periodontists primarily placing them left and right. Its a shame, because had they been the specialty that was also known for implants, endo would have been hands down the most lucrative specialty...

 

[armorshell]

The BIGGEST mistake, i think, that endodontists made was not accepting and embracing implants early on. If you really think about it, it makes perfect sense ultimately for an endodontist to be the primary specialist to place implants - you send a pt in for a consult, if they can't save the tooth via RCT they can pop it out and put an implant in. Unfortunately due to stubborness on their part to avoid embracing that important technology, now you have OMS and Periodontists primarily placing them left and right. Its a shame, because had they been the specialty that was also known for implants, endo would have been hands down the most lucrative specialty...

Endo might already be the most lucrative specialty, and the "endodontist as the perfect specialist to place implants" is the most tenous argument I've heard repeated on these boards in a long time. Sure, failed endo and implant therpay form a continuum but how does that make an endodontist the perfect person to place an implant? Maybe it's my naivete of still being in academics but evaluation by a restorative dentist prior to implant placement seems like an important step in the process and if I were a general dentist I think I'd be pretty peeved if I sent my patient for a RCT and they came back with an implant.

 

[DrReo]

"Fifty-seven percent (57%) of respondents

believed that implant placement should be within the scope of endodontic
practice, 5.7% stated that they currently placed implants, and 25.4% were
interested in placing implants in the future. Multivariable logistic regression
using a forward stepwise selection model identified 5 variables that
were statistically significantly associated with the view that endodontists
should place implants (​

​

​

​

P < 0.05). In the final model, endodontists were
13.15 times (CI 7.68-22.50) more likely to believe that implant placement​

should be incorporated into the endodontic curriculum."

Should endodontists place implants? A survey of U.S. endodontists.​

​

​

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Potter, K. S., M. R. McQuistan, et al. J Endod (2009);35(7): 966-70.

Interesting 😀​

 

[Stroszeck]

Um actually oral surgery is the "most lucrative" specialty as most people know...these guys can earn $500,000 right out of school in a good area with minimal on call and hospital duty....