Endodontic Practice Versus General Dentistry in Los Angeles County- need advise from endo and GP

[cu4fun2]

I appreciate your advice/ opinion.
I understand that right now it is now a good time for any of the fields compared to before Covid.
I wonder if in your opinion do you recommend being an owner of a general dental office or an endodontic office in LA county in terms of income? Im sure you realize that most endodontist may accept many insurance plans, and reimbursement for endo can vary from $700-$1100 with most companies.
Which business model is more likely to produce more income and net more for the owner : Endodontic office or General Dentistry ?
The advantages I see in a general dental practice:
Hygiene department , ability to offer variety of treatments that insurance does not normally cover: veneers, invisalign, implants, and many more.
Thank you

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[cu4fun2]

Any opinion is appreciated , thank you

 

[Big Time Hoosier]

in LA county

My opinion? Just leave.

Big Hoss

 

[2TH MVR]

Yeah. LA has to be a tough environment to practice in. Not a GP, but I'll throw in my opinion.

Most important factor is? What do you want to do as a lifelong profession? Endo or general practice? In a perfect world ... you go to work happy with what you do. Trust me. Being happy is ultra important and I'm a HAPPY orthodontist. When you are content with your profession .... success will find you eventually.

One of the positives to Endo is the ability to run a very low overhead type of office. The negative is that you will rely on dentist referrals and being a provider for insurance companies. Are you comfortable and outgoing enough to solicit referrals? Personally .... I never liked the whole process of trying to be popular with the general dentists to get their referrals. I did it out of necessity.

As for money. We've all heard that endos can make some decent coin and of course there are always those high producing general practices also.

Bottomline. Do what will make you happy. The money will come later.

 

[periopocket]

Go on dentaltown classifieds and 4salebydentist.com look at how private practices are doing in your area of interest.

All types of dentists can do very well, specialists on average, especially endo tend to do better then GPs...but I’ve seen all types of dentist business owners do well

 

[allDAT]

LA County is really difficult for everyone. There are a lot of reasons for that, but the best advice is to leave. If you need to be close to LA and your primary goal is income, look at Ventura County as an endo.

 

[cu4fun2]

Yeah. LA has to be a tough environment to practice in. Not a GP, but I'll throw in my opinion.

Most important factor is? What do you want to do as a lifelong profession? Endo or general practice? In a perfect world ... you go to work happy with what you do. Trust me. Being happy is ultra important and I'm a HAPPY orthodontist. When you are content with your profession .... success will find you eventually.

One of the positives to Endo is the ability to run a very low overhead type of office. The negative is that you will rely on dentist referrals and being a provider for insurance companies. Are you comfortable and outgoing enough to solicit referrals? Personally .... I never liked the whole process of trying to be popular with the general dentists to get their referrals. I did it out of necessity.

As for money. We've all heard that endos can make some decent coin and of course there are always those high producing general practices also.

Bottomline. Do what will make you happy. The money will come later.

Thank you for taking the time to reply - The over head can be pretty the same . In a dental office you have : rent, at least 3 emplyees. This can be the same for GP and endo. Maybe GP that gets busy will need 1-2 more assistance - but that is because the practice is busy with patients and most likely making money - so net will be higher even after paying those 1-2 additional employees

 

[periopocket]

Thank you for taking the time to reply - The over head can be pretty the same . In a dental office you have : rent, at least 3 emplyees. This can be the same for GP and endo. Maybe GP that gets busy will need 1-2 more assistance - but that is because the practice is busy with patients and most likely making money - so net will be higher even after paying those 1-2 additional employees

Yes, endo adding CT, Rotary, scopes, and wave one has gotten overhead close to many fee for service gp practices.

 

[cu4fun2]

Yes, endo adding CT, Rotary, scopes, and wave one has gotten overhead close to many fee for service gp practices.

That is true also.
But all those equipment enhance the treatment process, efficiency, and success.

 

[2TH MVR]

Isn't staff costs traditionally the highest part of practice overhead? Of course if you buy (read: finance, lease) all the bells and whistles whether you are an Endo or GP ... of course the OH will go up.

My point is that most Endo practices can operate with fewer staff. This is an advantage. Staff management is a whole new discussion. Ask any dentist what part of running a practice is the most stressful. They will tell you Staff Management. The more staff you have .... the higher the stress. While I was in private practice .. I used to have a staff of 8 FT and 1-2 PT employees. Towards the end of my PP days. ... I was down to 4 FT staff. Trust me. Life was so much easier, less stressful with a smaller staff.

 

[Trigeminal08]

Wrath of Delta is about to hit us in 2021

Article Details

 

[periopocket]

Wrath of Delta is about to hit us in 2021

Article Details

That’s a shame...

It’s not fair

 

[MidwestOwl]

Yes, endo adding CT, Rotary, scopes, and wave one has gotten overhead close to many fee for service gp practices.

i have to disagree on this though. scopes are quite cheap about 20k each, and you can use them for 20 years plus with almost zero maintenance. If you wanna be cheap, you can have one microscope for the entire office to use on difficult cases and then loupes for simple cases. CBCT is a little expensive but it tends pay for itself quickly. At my office, each CBCt costs patients 260 cash (due to no insurance coverage). At endo office, we take CBCt for 40-50% of cases. So everyday 4-5 CBCTs are taken, you can do the maths.

 

[MidwestOwl]

Any opinion is appreciated , thank you

I think LA is a great place to live for some but not a great place to work for any average dentists....I live right across from NYC cuz I like to come back to my apartment on Sat to enjoy my weekend. No way in hell, I would work as an endodontist in NYC. Assuming the job aspect of NYC and LA are similar, I would kill myself if i have to do 5-6 retreats per day that were f%^% up by greedy and young GPs

 

[FutureDent020]

i have to disagree on this though. scopes are quite cheap about 20k each, and you can use them for 20 years plus with almost zero maintenance. If you wanna be cheap, you can have one microscope for the entire office to use on difficult cases and then loupes for simple cases. CBCT is a little expensive but it tends pay for itself quickly. At my office, each CBCt costs patients 260 cash (due to no insurance coverage). At endo office, we take CBCt for 40-50% of cases. So everyday 4-5 CBCTs are taken, you can do the maths.

Agree with all this. These are one time office expenses, but I don’t believe they fall in the overhead category. Of course every office is different but on average a GP office runs over 60% overhead. Endodontic offices are around 40%, probably lower. Obviously both these numbers can be lower. But an endodontist who wants to run at a low overhead will always run lower than a GP who wants to run at a low over head. And then add price/ procedure, an endodontist is going to win that as well. Now a GP’s office can bring in more $$ with hygiene and number of procedures performed. Question is, will a private GP (1 provider office) produce 25- 30% more than a private endo (1 provider office) in the LA area? I have no clue, but I would hedge on the endo covering that margin.

 

[MidwestOwl]

I appreciate your advice/ opinion.
I understand that right now it is now a good time for any of the fields compared to before Covid.
I wonder if in your opinion do you recommend being an owner of a general dental office or an endodontic office in LA county in terms of income? Im sure you realize that most endodontist may accept many insurance plans, and reimbursement for endo can vary from $700-$1100 with most companies.
Which business model is more likely to produce more income and net more for the owner : Endodontic office or General Dentistry ?
The advantages I see in a general dental practice:
Hygiene department , ability to offer variety of treatments that insurance does not normally cover: veneers, invisalign, implants, and many more.
Thank you

I think if you were "realistically" able to deliver 6 veneers/ place 4-5 implants per day every day as a solo GP owner, you would out-earn most solo endo owners out there. However, i guess it would be quite difficult to do that many high end procedures daily in an extremely competitive market like LA in a tough economy unless you were one of those Beverly Hills dentists. endodontist owner, on the other hands, can realistically do 6-10 cases per day as long as he has a good referral network. The beautiful thing about endo is when patients are in pain, they have to cough up money to get rid of the pain... implants/ veneers/ invisalign all can be postponed

 

[cu4fun2]

I think LA is a great place to live for some but not a great place to work for any average dentists....I live right across from NYC cuz I like to come back to my apartment on Sat to enjoy my weekend. No way in hell, I would work as an endodontist in NYC. Assuming the job aspect of NYC and LA are similar, I would kill myself if i have to do 5-6 retreats per day that were f%^% up by greedy and young GPs

Do own an endo practice on your own now ?

 

[cu4fun2]

Agree with all this. These are one time office expenses, but I don’t believe they fall in the overhead category. Of course every office is different but on average a GP office runs over 60% overhead. Endodontic offices are around 40%, probably lower. Obviously both these numbers can be lower. But an endodontist who wants to run at a low overhead will always run lower than a GP who wants to run at a low over head. And then add price/ procedure, an endodontist is going to win that as well. Now a GP’s office can bring in more $$ with hygiene and number of procedures performed. Question is, will a private GP (1 provider office) produce 25- 30% more than a private endo (1 provider office) in the LA area? I have no clue, but I would hedge on the endo covering that margin.

This is the question: Hygiene will continuously generate income while the operator(endodontist) is busy in one operatory. Also - less timing consulimg procedures at the GP office - whitening , Fluoride, periodontal irrigation, can generate income. Also - implant placement and restoration - large production cases. In addition, if can learn and treat some invisalign cases- it can attract patients and referrals through happy patients- a lot of options for sustaining and growing a business practice, compared to Endo- what are your thoughts?

 

[cu4fun2]

I think if you were "realistically" able to deliver 6 veneers/ place 4-5 implants per day every day as a solo GP owner, you would out-earn most solo endo owners out there. However, i guess it would be quite difficult to do that many high end procedures daily in an extremely competitive market like LA in a tough economy unless you were one of those Beverly Hills dentists. endodontist owner, on the other hands, can realistically do 6-10 cases per day as long as he has a good referral network. The beautiful thing about endo is when patients are in pain, they have to cough up money to get rid of the pain... implants/ veneers/ invisalign all can be postponed

Your opinion on cough up money is true; however, many patients have insurances these days - and these patients watch their co=pay and contractual agreement numbers very closely. I find that insurance companies are reimbursing very low on endodontic treatment these days.

 

[cu4fun2]

Wrath of Delta is about to hit us in 2021

Article Details

I know, i think delta delta was paying the most to specialist . now that will be reduced then reimbursement for endo pocedures will be under 1000$
Where do you practice endo ?

 

[MidwestOwl]

Your opinion on cough up money is true; however, many patients have insurances these days - and these patients watch their co=pay and contractual agreement numbers very closely. I find that insurance companies are reimbursing very low on endodontic treatment these days.

Most ppl didnt seem to have problem paying, at least in the area that i worked. patients seemed to know what they are about to pay before showing up at our office. We dont take medicaid, DHMO or lower tier PPO. We charged patients 280 for consults. After insurance discount, the lowest that we get for molar for consult and rct combined is about 870, the highest is 1300-1400 . Aetna seemed to be the most generous right now. Please leave LA, the la la land is not good for dentistry, period. 1.5 or 2 hours from big city is usually the best for business.

 

[MidwestOwl]

This is the question: Hygiene will continuously generate income while the operator(endodontist) is busy in one operatory. Also - less timing consulimg procedures at the GP office - whitening , Fluoride, periodontal irrigation, can generate income. Also - implant placement and restoration - large production cases. In addition, if can learn and treat some invisalign cases- it can attract patients and referrals through happy patients- a lot of options for sustaining and growing a business practice, compared to Endo- what are your thoughts?

if you want to do really really well as an endodontist, you should be prepared to run back and forth comfortably between 2 production chairs. Most rcts take 1-1.5 hour to finish but 30 mins of that is to wait for NaOCl to work. After c/s, you can ask your assistant to use endoactivator on the first patient while you run to the second patient to do access opening and c/s. After c/s on the second pt, you can come back to the first pt to obturate . Rinse, repeat. By staggering your schedule like what i said, you can theoretically see 10-12 patients per day without compromising RCT quality.

What i was trying to tell you is if you have enough patients to perform those high end procedures such as veneers and implants regularly, you will do really well as a GP. at the end of the day, it boils down to how good you are at selling treatments to patients. No treatments, no money. Most solo GPs dont earn as much as solo OMFS or endo because they usually dont have enough cases to constantly produce 1200/ hour, each day, and every day. to be a busy endodontist, you need to have 20-30 GP offices that constantly refer 3-4 cases per month to your office. in addition, overhead of GP offices tends to be in the high 60%. At endo offices, overhead tends to be in the high 30%. Yes, hygientists make money for you but you have to pay them well to keep them. you only have to pay dental assistant 15-20 bucks an hour. Hygienist salary is much higher.

One of my endo faculty in residency has his office on fifth avenue NYC where he charges patients 2500 cash for molar endo. I wish i were that desirable. Endo tend to reach the income ceiling quite early in their career though. Do you reallly have to make more than 500k per year before tax to be happy??? probably not. if you wanna take home 1mish before tax, OMFS is probably the only one that has that kind of income potential on average...

 

[cu4fun2]

if you want to do really really well as an endodontist, you should be prepared to run back and forth comfortably between 2 production chairs. Most rcts take 1-1.5 hour to finish but 30 mins of that is to wait for NaOCl to work. After c/s, you can ask your assistant to use endoactivator on the first patient while you run to the second patient to do access opening and c/s. After c/s on the second pt, you can come back to the first pt to obturate . Rinse, repeat. By staggering your schedule like what i said, you can theoretically see 10-12 patients per day without compromising RCT quality.

What i was trying to tell you is if you have enough patients to perform those high end procedures such as veneers and implants regularly, you will do really well as a GP. at the end of the day, it boils down to how good you are at selling treatments to patients. No treatments, no money. Most solo GPs dont earn as much as solo OMFS or endo because they usually dont have enough cases to constantly produce 1200/ hour, each day, and every day. to be a busy endodontist, you need to have 20-30 GP offices that constantly refer 3-4 cases per month to your office. in addition, overhead of GP offices tends to be in the high 60%. At endo offices, overhead tends to be in the high 30%. Yes, hygientists make money for you but you have to pay them well to keep them. you only have to pay dental assistant 15-20 bucks an hour. Hygienist salary is much higher.

One of my endo faculty in residency has his office on fifth avenue NYC where he charges patients 2500 cash for molar endo. I wish i were that desirable. Endo tend to reach the income ceiling quite early in their career though. Do you reallly have to make more than 500k per year before tax to be happy??? probably not. if you wanna take home 1mish before tax, OMFS is probably the only one that has that kind of income potential on average...

500K before tax and overhead? is this what to expect?

 

[cu4fun2]

if you want to do really really well as an endodontist, you should be prepared to run back and forth comfortably between 2 production chairs. Most rcts take 1-1.5 hour to finish but 30 mins of that is to wait for NaOCl to work. After c/s, you can ask your assistant to use endoactivator on the first patient while you run to the second patient to do access opening and c/s. After c/s on the second pt, you can come back to the first pt to obturate . Rinse, repeat. By staggering your schedule like what i said, you can theoretically see 10-12 patients per day without compromising RCT quality.

What i was trying to tell you is if you have enough patients to perform those high end procedures such as veneers and implants regularly, you will do really well as a GP. at the end of the day, it boils down to how good you are at selling treatments to patients. No treatments, no money. Most solo GPs dont earn as much as solo OMFS or endo because they usually dont have enough cases to constantly produce 1200/ hour, each day, and every day. to be a busy endodontist, you need to have 20-30 GP offices that constantly refer 3-4 cases per month to your office. in addition, overhead of GP offices tends to be in the high 60%. At endo offices, overhead tends to be in the high 30%. Yes, hygientists make money for you but you have to pay them well to keep them. you only have to pay dental assistant 15-20 bucks an hour. Hygienist salary is much higher.

One of my endo faculty in residency has his office on fifth avenue NYC where he charges patients 2500 cash for molar endo. I wish i were that desirable. Endo tend to reach the income ceiling quite early in their career though. Do you reallly have to make more than 500k per year before tax to be happy??? probably not. if you wanna take home 1mish before tax, OMFS is probably the only one that has that kind of income potential on average...

How many years are you practicing in endo office- have you seen a noticeable decrease in referrals? in anterior and premolar referrals ? (those are usually faster to complete RCT, and thereofre more production per hour of work. ) getting all retreat is really a loss in revenue not gain - many of them take to appointments and longer time each appointment

 

[MidwestOwl]

500K before tax and overhead? is this what to expect?

im still an associate, but my boss usually takes home, aka nets, about 6-7k after overhead but before tax everyday. You will do well as endo if you are good and fast. For me, as a new grad, 400k before tax is very doable

 

[shmebeble]

im still an associate, but my boss usually takes home, aka nets, about 6-7k after overhead but before tax everyday. You will do well as endo if you are good and fast. For me, as a new grad, 400k before tax is very doable

If I am not mistaken you were able to do ~500 cases in residency and had 6-7 years of experience before residency. You are unique in your speed while also taking quality into consideration. most recent grads should not expect that.

 

[shmebeble]

if you want to do really really well as an endodontist, you should be prepared to run back and forth comfortably between 2 production chairs. Most rcts take 1-1.5 hour to finish but 30 mins of that is to wait for NaOCl to work. After c/s, you can ask your assistant to use endoactivator on the first patient while you run to the second patient to do access opening and c/s. After c/s on the second pt, you can come back to the first pt to obturate . Rinse, repeat. By staggering your schedule like what i said, you can theoretically see 10-12 patients per day without compromising RCT quality.

What i was trying to tell you is if you have enough patients to perform those high end procedures such as veneers and implants regularly, you will do really well as a GP. at the end of the day, it boils down to how good you are at selling treatments to patients. No treatments, no money. Most solo GPs dont earn as much as solo OMFS or endo because they usually dont have enough cases to constantly produce 1200/ hour, each day, and every day. to be a busy endodontist, you need to have 20-30 GP offices that constantly refer 3-4 cases per month to your office. in addition, overhead of GP offices tends to be in the high 60%. At endo offices, overhead tends to be in the high 30%. Yes, hygientists make money for you but you have to pay them well to keep them. you only have to pay dental assistant 15-20 bucks an hour. Hygienist salary is much higher.

One of my endo faculty in residency has his office on fifth avenue NYC where he charges patients 2500 cash for molar endo. I wish i were that desirable. Endo tend to reach the income ceiling quite early in their career though. Do you reallly have to make more than 500k per year before tax to be happy??? probably not. if you wanna take home 1mish before tax, OMFS is probably the only one that has that kind of income potential on average...

What is the feedback from patients when you leave the room when NaOCl is working? How do you communicate this step to them?

 

[MidwestOwl]

What is the feedback from patients when you leave the room when NaOCl is working? How do you communicate this step to them?

you can tell them that the medication takes 15-20 more mins to kill bacteria, you will let the assistant mix the medication . you will come back later to finish. pts never have any problems with that