Endodontists: Have you seen noticeable decrease in referrals ?

[cu4fun2]

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I would like to get a view point from endodontists : Have you noticed a decrease in referral to your private practices ? Do you suspect that an endodontic practice is / or is not a good business model for earning a high income through practicing dentistry? Is it recommended to operate a general dental practice nowadays ?
I appreciate any input. Thank you

 

[yappy]

I would like to get a view point from endodontists : Have you noticed a decrease in referral to your private practices ? Do you suspect that an endodontic practice is / or is not a good business model for earning a high income through practicing dentistry? Is it recommended to operate a general dental practice nowadays ?
I appreciate any input. Thank you

I still refer cases I cannot do to my endodontist(s). I have more dentistry than time to screw around with complex endo cases so it's still an easy decision for me.

 

[Lassy]

I am not an Endodontist, but I can tell you as a GP I always refer when I see the RT is not a very easy one. It is a crazy the number of failed endo RCT I see on a regular basis. I don’t want to waste my time removing the crown, the cast post And core, and so on, and realize the canal is super thin or calcified. Waste of my time. I know a regular GP that loves to challenge herself with the whole procedure, but she ends up wasting hours on it and at the end ends up referring to an endo.

 

[cu4fun2]

I still refer cases I cannot do to my endodontist(s). I have more dentistry than time to screw around with complex endo cases so it's still an easy decision for me.

How many of these complex cases you encounter a month that you want to refer out

 

[cu4fun2]

I am not an Endodontist, but I can tell you as a GP I always refer when I see the RT is not a very easy one. It is a crazy the number of failed endo RCT I see on a regular basis. I don’t want to waste my time removing the crown, the cast post And core, and so on, and realize the canal is super thin or calcified. Waste of my time. I know a regular GP that loves to challenge herself with the whole procedure, but she ends up wasting hours on it and at the end ends up referring to an endo.

How many of these complex cases you encounter a month that you want to refer out

 

[yappy]

How many of these complex cases you encounter a month that you want to refer out

3-6. Just in case you're interested in endo I would not go about things this way on SDN. You're only going to get a few responses from a few dentists. If you want to exclusively do endo then become an endodontist and offer the highest level of care to your referring dentists and patients. However, if you don't want to do that then endo is not a good choice. You will not go wrong being a dentist, or endodontist, so long as you keep your debt low. Just do what you like.

 

[allDAT]

I don’t think the audience you’re looking for is here.
The number of people we refer to endo has decreased due to the pandemic and their unemployment. When employment returns to normal, hopefully that turns around.

 

[Cold Front]

If you go into endodontics for money you are making a mistake.

One of my former associates did exactly that. He didn’t like income from general dentistry, so he chose to go back to school for Endo - to make more money.

 

[yappy]

One of my former associates did exactly that. He didn’t like income from general dentistry, so he chose to go back to school for Endo - to make more money.

To be fair the daily minimum at corporate offices is higher for specialists than non-specialists. Where I work at least, the floor that specialists earn is ~2x higher than my minimum. What is more difficult to determine is if they make more in terms of percentage of collections. I guess that is really dentist to dentist. This career is not straightforward. No one can bank on "if I do x and y I'll make z". Which is why I think it's best to just do what you enjoy while minimizing debt.

 

[Cold Front]

To be fair the daily minimum at corporate offices is higher for specialists than non-specialists. Where I work at least, the floor that specialists earn is ~2x higher than my minimum. What is more difficult to determine is if they make more in terms of percentage of collections. I guess that is really dentist to dentist. This career is not straightforward. No one can bank on "if I do x and y I'll make z". Which is why I think it's best to just do what you enjoy while minimizing debt.

That’s very true. The % of daily production for specialists is higher, but they may not necessarily take more money home than general dentists.

Endodontists typically get 40-45% of their production, and see 4-5 cases a day at about $1,200 per case on average (depending on where you practice) - which would equate to ~$2k take home for the day in this example.

A general dentist with a 30-35% deal on their production could see 20-30 patients a day (including hygiene checks, a denture, couple of crown and bridge, emergency cases, etc) and produce $5-6k a day and take about ~$2k a day home too - with no referrals needed to see their patients.

Those are just examples, based on the endodontists and general dentists I know.

 

[2TH MVR]

Honest question. Is endo that interesting? If the money was the same for all specialties .... would you still pick endo?

 

[Cold Front]

If you want to spend a career as a corporate associate, then sure, you’ll do better as a specialist. Endos get 40-50%. Read what I said above about doing this though. IMO, If you spend a career as a corporate associate, You are doing it all wrong. You have to look beyond that.

The American Dream has always been and will always be - having your own business (or Dental Office for a dentist).

 

[Cold Front]

Honest question. Is endo that interesting? If the money was the same for all specialties .... would you still pick endo?

I would do ortho if all money were equal. Less effort and more talking.

 

[Boat on the Chesapeake]

Honest question. Is endo that interesting? If the money was the same for all specialties .... would you still pick endo?

I think most people would find ortho or oral surgery more interesting if all the incomes were equal. Endo would be really repetitive if you’re only doing it for X% more money but there’s definitely a percentage of dentists that prefer it. Look how popular the Endo section of DentalTown is.

One thing is you have to sell and chit chat a lot as a GP or Ortho. With endo, you either want to save your tooth or you don’t. And you get to focus on that procedure, usually literally one tooth, and do a good job without distractions.

Also, in Coldfront’s example the GP is seeing 20-30 patients and hygiene checks to make the same income. That takes more more staff, and advertising plus insurance networks, to support that patient base. Much harder seeing dozens of patients (ortho, peds,GP) with Covid protocol for the near to medium future.

Pros and cons to everything. Don’t do something you hate for money.

 

[endodonia]

Endodontists typically get 40-45% of their production, and see 4-5 cases a day

A general dentist with a 30-35% deal on their production could see 20-30 patients a day

In cold fronts example above the take home pay was equal (about $2k). but is it really equal?
I really enjoy endo and have pursued specializing in it, therefore, I am extremely biased. I could write a book on all of the reasons why I wanted to pursue endo (aside from actually being very interested in the science and enjoying the procedure) but the bolded above would be in my "top 5" reasons.

my #1 reason, honestly, is staff. I predict myself to have a skeleton crew team. no hygienist= exponentially happier life for me. I also really enjoy endo and if money were equal I would pursue it again. You could argue $ is better as a GP if you have to pay to specialize (opportunity cost, lost income that compounds via investments, more debt, etc). I just wanted to enjoy what I did and be challenged every day.

Honest question. Is endo that interesting? If the money was the same for all specialties .... would you still pick endo?

if you are a philosophical person, yes, absolutely. The art of endodontics is not in doing a root canal, it is diagnosis. Diagnosis can be extremely difficult and interesting. plus technology keeps advancing and keeping you on your toes.

 

[Cold Front]

In cold fronts example above the take home pay was equal (about $2k). but is it really equal?

True. It’s not truly equal, but in my example of the general dentist, that’s with experience and high motivation - which unfortunately many general dentists fall short on. Hence why my former associate felt becoming an Endodontist was the answer to his engima.

This profession can only give a dentist or a specialist as much they put into it. Nothing is by default. You can specialize, but you won’t get paid a higher income than a general dentist by just being a specialist and without still hustling. Endo is tough, and highly stressful - so no one should pursue those trenches to make extra 100k or 2 if they don’t enjoy doing it.

 

[MidwestOwl]

In cold fronts example above the take home pay was equal (about $2k). but is it really equal?
I really enjoy endo and have pursued specializing in it, therefore, I am extremely biased. I could write a book on all of the reasons why I wanted to pursue endo (aside from actually being very interested in the science and enjoying the procedure) but the bolded above would be in my "top 5" reasons.

my #1 reason, honestly, is staff. I predict myself to have a skeleton crew team. no hygienist= exponentially happier life for me. I also really enjoy endo and if money were equal I would pursue it again. You could argue $ is better as a GP if you have to pay to specialize (opportunity cost, lost income that compounds via investments, more debt, etc). I just wanted to enjoy what I did and be challenged every day.



if you are a philosophical person, yes, absolutely. The art of endodontics is not in doing a root canal, it is diagnosis. Diagnosis can be extremely difficult and interesting. plus technology keeps advancing and keeping you on your toes.

I wouldnt say I love endo to death. I did come back to residency to make more money and I like the endo lifestyle much better. Even with crappy insurance reimbursement these days, on average I still take home about 250-300 per hour before tax, which is not bad at all in this ecconomy. the thing i notice about endo is established/ older Gps dont like to it at all. As a result, as long as you have enough established/ older GPs to refer patients to you, you will do really well. Endo tends to reach income ceiling much quicker than perio or OMFS since as endodontist, you can only do 10-12 good RCTs max per day. Doing more than 15 per day will drive you insane and reduce your quality significantly. So if perio/ prosth can consistently deliver 6 veneers/ crowns or placed 4-5 implants per day, they can definitely make more than most/ all established endo, but in this economy, it will be quite hard

 

[Cold Front]

you can only do 10-12 good RCTs max per day.

80% of endodontists do 4-6 cases a day 90% of the time. No?

 

[MidwestOwl]

80% of endodontists do 4-6 cases a day 90% of the time. No?

my boss is running between 2 chairs and doing 10 per day. Why limitt yourself? im slow but im doing 4-5 right now. Hopwfully in 1-2 years months would be 6-7

 

[Torshammer]

my boss is running between 2 chairs and doing 10 per day. Why limitt yourself? im slow but im doing 4-5 right now. Hopwfully in 1-2 years months would be 6-7

Finishing 4-5 cases? Or just opening/instrumenting? Also, in addition to the 4-5 cases how many consults are you seeing?

 

[shmebeble]

80% of endodontists do 4-6 cases a day 90% of the time. No?

Yes. Doing more than 6 one can argue quality goes down as well.

 

[MidwestOwl]

Finishing 4-5 cases? Or just opening/instrumenting? Also, in addition to the 4-5 cases how many consults are you seeing?

i usually do 4-5 consults on top of 4-5 cases

 

[MidwestOwl]

Yes. Doing more than 6 one can argue quality goes down as well.

if you stagger chair time and let NaOCl in the canals for at least 45 mins per pts. Since half of the rct time is to wait for bleach to work, you dont have to be with patients during that time. It shouldnt affect the quality though

 

[Cold Front]

my boss is running between 2 chairs and doing 10 per day. Why limitt yourself? im slow but im doing 4-5 right now. Hopwfully in 1-2 years months would be 6-7

True. Just like anything else, dentistry speed and productivity is a bell curve. Your boss is at the peak of his game... but can he sustain that for another 5-10 years? You are heading towards your peak, but peaks are meant to be brief - as in years, not the entire career.

 

[MidwestOwl]

True. Just like anything else, dentistry speed and productivity is a bell curve. Your boss is at the peak of his game... but can he sustain that for another 5-10 years? You are heading towards your peak, but peaks are meant to be brief - as in years, not the entire career.

he has been making 6-7k per day for the last 10 years and probably 10 more...i think it is more than enough

 

[Torshammer]

i usually do 4-5 consults on top of 4-5 cases

How many of the 4-5 cases are finishes though? And how many years out are you? Thanks, I'm a current endo resident, trying to get a gauge of speed in private practice.

 

[LaughingGas]

It really depends how moral/ethical GPs are. I have pool of patients from a nearby office that the dentist retired and 90% of RCTs done by that dentists have SAP, AAP with underfilled canals.

 

[yappy]

It really depends how moral/ethical GPs are. I have pool of patients from a nearby office that the dentist retired and 90% of RCTs done by that dentists have SAP, AAP with underfilled canals.

I see this every day. At the Corp I work at we have a new hire that insists on doing rct but wears 2.5 mag loupes, doesn't use an apex locator, and single cone obturates every canal.

 

[FutureDent020]

80% of endodontists do 4-6 cases a day 90% of the time. No?

Just interviewed and visited 4 different offices. Slower providers were still seeing 5-6. Faster providers were seeing 8-9. Didn’t see anyone doing double digits. I think one point people are missing here are the consults. I was also seeing at least 3-4 consults/ day on the schedule for each provider and these were reimbursing at $300/ piece. So add that to your production for the day. Most of the TDO annual productions per provider I saw were around $1 million. Older guys were higher (saw what I thought was a $1.8 mill but maybe it was 1.5), younger guys were lower in the $700,000-$800,000. Collections were generally high. At least 90%, some 100%, I was also hearing that associates were taking 40% of collections, not production btw. But it sounded like for some offices there was little difference there. Most offers are going to be 40% with a signing bonus. This was not in LA, NY, or a huge city, but it was a popular city.

 

[Steins;Gate]

Just interviewed and visited 4 different offices. Slower providers were still seeing 5-6. Faster providers were seeing 8-9. Didn’t see anyone doing double digits. I think one point people are missing here are the consults. I was also seeing at least 3-4 consults/ day on the schedule for each provider and these were reimbursing at $300/ piece. So add that to your production for the day. Most of the TDO annual productions per provider I saw were around $1 million. Older guys were higher (saw what I thought was a $1.8 mill but maybe it was 1.5), younger guys were lower in the $700,000-$800,000. Collections were generally high. At least 90%, some 100%, I was also hearing that associates were taking 40% of collections, not production btw. But it sounded like for some offices there was little difference there. Most offers are going to be 40% with a signing bonus. This was not in LA, NY, or a huge city, but it was a popular city.

Are these providers working 3 days per week?

 

[Cold Front]

Just interviewed and visited 4 different offices. Slower providers were still seeing 5-6. Faster providers were seeing 8-9. Didn’t see anyone doing double digits. I think one point people are missing here are the consults. I was also seeing at least 3-4 consults/ day on the schedule for each provider and these were reimbursing at $300/ piece. So add that to your production for the day. Most of the TDO annual productions per provider I saw were around $1 million. Older guys were higher (saw what I thought was a $1.8 mill but maybe it was 1.5), younger guys were lower in the $700,000-$800,000. Collections were generally high. At least 90%, some 100%, I was also hearing that associates were taking 40% of collections, not production btw. But it sounded like for some offices there was little difference there. Most offers are going to be 40% with a signing bonus. This was not in LA, NY, or a huge city, but it was a popular city.

Great info. Couple of takeaways with the 90% collection:

1. Seasoned endodontists at that office probably make 40% on their 1.35M collection = $540k/yr.

2. Younger, less experienced guys also probably make 40% of their $670-720k collection = $268-$288k/yr.

Just like in general dentistry or other specialties, it’s all relative to your speed, your location and collection. Do what you enjoy doing (don’t specialize for the money), be good at it (speed), and make sure the patients and insurances pay 100%.

 

[cu4fun2]

That’s very true. The % of daily production for specialists is higher, but they may not necessarily take more money home than general dentists.

Endodontists typically get 40-45% of their production, and see 4-5 cases a day at about $1,200 per case on average (depending on where you practice) - which would equate to ~$2k take home for the day in this example.

A general dentist with a 30-35% deal on their production could see 20-30 patients a day (including hygiene checks, a denture, couple of crown and bridge, emergency cases, etc) and produce $5-6k a day and take about ~$2k a day home too - with no referrals needed to see their patients.

Those are just examples, based on the endodontists and general dentists I know.

You are right. Still as a general dentist in order to make the respected income we desire as dentists- it is better to own a practice than being an asssociate and receiving 25-30% of adjusted production. If the GP usually produces 5K per day- then the take home is a lot more as an owner.

 

[cu4fun2]

If you want to spend a career as a corporate associate, then sure, you’ll do better as a specialist. Endos get 40-50%. Read what I said above about doing this though. IMO, If you spend a career as a corporate associate, You are doing it all wrong. You have to look beyond that.

totally agree, unless you want to focus more on family and yourself and less on career - then associate is good

 

[cu4fun2]

Are these providers working 3 days per week?

It is a lot harder to get established and get referrals to see that many patients and produce / collect so much money in an endo practice - whereas GP practice - you can purchase a good practice and start producing 4-5K / day faster

 

[cu4fun2]

he has been making 6-7k per day for the last 10 years and probably 10 more...i think it is more than enough

When did you graduate Endo ?