For the dentists out there who can help...

[fellowstudent92]

Hello everybody,

So I am currently a dental student . I go to a reputable state dental school, where I will graduate with minimal (<$20,000), if not nothing (if my parents end up paying that amount) in debt. I realize I am in a very unique position in this day and age, with cost of dental school skyrocketing and I count my blessings. If you were in this position, what would be your strategy post graduation? I do have interest in specializing in endo but I have been weighing this for sometime now and feel that instead of specializing, financially it would be smarter to be a GP and just learn endo from CE classes. And be super aggressive about it. It's making me hesitant about specializing, b/c I don't want to put myself in more debt even though I could get away with it. I just don't know if the payoffs would be worth it, even though I am interested in endo. (why do endo as a specialty when I could do GP and do endo and save 2 or 3 years in the process via some high quality CE classes that may be on the more expensive end but not as expensive as residency?). Also, would you become an associate or would you go straight to opening a practice/buying an established one, (assuming you had some sort of a mentor to help you through the process but wouldn't necessarily be working with you)? Or would you do a GPR first?

If this isn't the right forum to post this question, do you guys think dental town would be better?

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[vellnueve]

GP endo vs endodontist endo, even with CE courses, is an entirely different animal.

If you want to be an endodontist, go to residency. You'll make that money back fairly quickly oweing only for the two years of residency instead of the 6 total years of school and residency.

 

[Evik23]

Hello everybody,

So I am currently a dental student . I go to a reputable state dental school, where I will graduate with minimal (<$20,000), if not nothing (if my parents end up paying that amount) in debt. I realize I am in a very unique position in this day and age, with cost of dental school skyrocketing and I count my blessings. If you were in this position, what would be your strategy post graduation? I do have interest in specializing in endo but I have been weighing this for sometime now and feel that instead of specializing, financially it would be smarter to be a GP and just learn endo from CE classes. And be super aggressive about it. It's making me hesitant about specializing, b/c I don't want to put myself in more debt even though I could get away with it. I just don't know if the payoffs would be worth it, even though I am interested in endo. (why do endo as a specialty when I could do GP and do endo and save 2 or 3 years in the process via some high quality CE classes that may be on the more expensive end but not as expensive as residency?). Also, would you become an associate or would you go straight to opening a practice/buying an established one, (assuming you had some sort of a mentor to help you through the process but wouldn't necessarily be working with you)? Or would you do a GPR first?

If this isn't the right forum to post this question, do you guys think dental town would be better?

When you are a gp, you may do about 5-10 root canals a week if you are really good and it takes a long time to become good even with the best ce. The rest of the time you will need to spend doing bread and butter dentistry which may not be as lucrative as just doing Endo procedures all day. When you are an endodontist, you do about 5-10 root canals a day. Big difference. I suggest you shadow some gp's and some Endo's to get a better idea. There is a huge difference in the case selection and the quality of the outcome. Most of all there is a vast difference in the patient experience. At the end of the day, if you are passionate about Endo, which is hard to develop while in school, go for it. The fact that you have no loans or very little loans should be even more of a motivation to do it and get it over with since there is no interest that is mounting for two years. If you need to explore your passion a little bit, nothing wrong with that, get out and do general dentistry for a few years.

To your second question, in my view, it will be hard to develop speed and precision in addition to managing a staff and running a practice right out of school. I suggest looking for an associate spot but be very particular. Don't jump at the first one you get. Make sure you have the freedom to plan your cases and are not just following the owners instructions. It's always nice to bounce ideas off more experienced dentists so a mentor would be very helpful to you.

 

[fellowstudent92]

When you are a gp, you may do about 5-10 root canals a week if you are really good and it takes a long time to become good even with the best ce. The rest of the time you will need to spend doing bread and butter dentistry which may not be as lucrative as just doing Endo procedures all day. When you are an endodontist, you do about 5-10 root canals a day. Big difference. I suggest you shadow some gp's and some Endo's to get a better idea. There is a huge difference in the case selection and the quality of the outcome. Most of all there is a vast difference in the patient experience. At the end of the day, if you are passionate about Endo, which is hard to develop while in school, go for it. The fact that you have no loans or very little loans should be even more of a motivation to do it and get it over with since there is no interest that is mounting for two years. If you need to explore your passion a little bit, nothing wrong with that, get out and do general dentistry for a few years.

To your second question, in my view, it will be hard to develop speed and precision in addition to managing a staff and running a practice right out of school. I suggest looking for an associate spot but be very particular. Don't jump at the first one you get. Make sure you have the freedom to plan your cases and are not just following the owners instructions. It's always nice to bounce ideas off more experienced dentists so a mentor would be very helpful to you.

I feel that the bolded assumes you will have enough patients who need root canals to sustain that volume everyday. If many GPs are starting to do more and more endo in our time, wouldn't that decrease patient pool for the endodontist to sustain that volume? On the flipside, if you were really good at doing endo procedures, the bread and butter of dentistry would be additional sources of revenue whereas root canals are the only source of revenue for an endodontist.

 

[tc434]

Unless you are certain you want to do root canals all day, everyday, then work as a general dentist for a bit after graduating. You can always go back and do a residency after a few years if you find you are not getting what you want out of being a general dentist. Having experience will help you during the application process.

 

[vellnueve]

I feel that the bolded assumes you will have enough patients who need root canals to sustain that volume everyday. If many GPs are starting to do more and more endo in our time, wouldn't that decrease patient pool for the endodontist to sustain that volume? On the flipside, if you were really good at doing endo procedures, the bread and butter of dentistry would be additional sources of revenue whereas root canals are the only source of revenue for an endodontist.

Most GPs don't want to waste a few hours doing endo when they can see multiple operative cases in that time.

Also, you're not going to have other GPs referring endo to you, so you're not going to have enough endo volume to do what you seem to want to do.

 

[setdoc7]

There are endo residencies that pay, as opposed to school based which charge tuition. Go to one of those. It will be less than private practice, but you will also not have to pay health insurance, malpractice, and lots of other private practice expenses. Board eligible is different from CE trained.

 

[fellowstudent92]

Very solid, thank you for the input everybody!

 

[fellowstudent92]

There are endo residencies that pay, as opposed to school based which charge tuition. Go to one of those. It will be less than private practice, but you will also not have to pay health insurance, malpractice, and lots of other private practice expenses. Board eligible is different from CE trained.

I would love to go to one of these, but they are so darn hard to get into from what I've read around here. I don't mind associating to see if general dentistry would be better, the issue is obviously the delayed ability to start up a (endo) practice if i only find out a couple years from graduation that endo is what i really wanted to do and I was right all along.

 

[Evik23]

I feel that the bolded assumes you will have enough patients who need root canals to sustain that volume everyday. If many GPs are starting to do more and more endo in our time, wouldn't that decrease patient pool for the endodontist to sustain that volume? On the flipside, if you were really good at doing endo procedures, the bread and butter of dentistry would be additional sources of revenue whereas root canals are the only source of revenue for an endodontist.

You are not wrong to feel that way and it is a valid concern. A prosthodontist once said to me, "the more complex work general dentists do, the more work we have to fix". At the time I had just graduated dental school and I thought this guy was full of ****. However, now after 3 years of general practice, I feel the same can apply to endodontics to some extent. I do plenty of endodontics in my practice but I do straight forward cases that I can finish or at least try to finish in a reasonable amount of time! I have done some through crowns and I have done some re-treats but they don't really work out in the long run in terms of maximizing my schedule. Most of all, the patient does not have the best experience. He may have a very good experience but not the best. I spent a lot of time shadowing endodontists before I pulled the trigger and applied for it. Most of their work is molar root canals through crowns, re-treats or apico's. If there is a pre-molar or an anterior on the schedule, it is mostly because they are heavily calcified or something else going on. This is what I mean by case selection. To my previous point, the more complex root canals general dentists do, the more work endodontists will have.

Another way to think of things and I have thought of this many ways. There are about 130-140 thousand general dentists in the United States and around 5-6 thousand endodontists. That is a ratio of about 20:1. Take my situation, I do plenty of endo but still send about 3-4 a week to the endodontist. Lets do 4 times 20 dentists which is 80 patients a week that a specialist would see. A lot of dentists still send all their endo cases out so there are plenty of teeth to work on.

At the end of the day, whether you are a general dentist or an endodontist, you need to love what you are doing and you need to be passionate about it. When you talk to your patients, they can tell what you are passionate about. You will be successful no matter what if you are doing it for the right reasons.

 

[fellowstudent92]

You are not wrong to feel that way and it is a valid concern. A prosthodontist once said to me, "the more complex work general dentists do, the more work we have to fix". At the time I had just graduated dental school and I thought this guy was full of ****. However, now after 3 years of general practice, I feel the same can apply to endodontics to some extent. I do plenty of endodontics in my practice but I do straight forward cases that I can finish or at least try to finish in a reasonable amount of time! I have done some through crowns and I have done some re-treats but they don't really work out in the long run in terms of maximizing my schedule. Most of all, the patient does not have the best experience. He may have a very good experience but not the best. I spent a lot of time shadowing endodontists before I pulled the trigger and applied for it. Most of their work is molar root canals through crowns, re-treats or apico's. If there is a pre-molar or an anterior on the schedule, it is mostly because they are heavily calcified or something else going on. This is what I mean by case selection. To my previous point, the more complex root canals general dentists do, the more work endodontists will have.

Another way to think of things and I have thought of this many ways. There are about 130-140 thousand general dentists in the United States and around 5-6 thousand endodontists. That is a ratio of about 20:1. Take my situation, I do plenty of endo but still send about 3-4 a week to the endodontist. Lets do 4 times 20 dentists which is 80 patients a week that a specialist would see. A lot of dentists still send all their endo cases out so there are plenty of teeth to work on.

At the end of the day, whether you are a general dentist or an endodontist, you need to love what you are doing and you need to be passionate about it. When you talk to your patients, they can tell what you are passionate about. You will be successful no matter what if you are doing it for the right reasons.

HAHA cool

 

[setdoc7]

I would love to go to one of these, but they are so darn hard to get into from what I've read around here. I don't mind associating to see if general dentistry would be better, the issue is obviously the delayed ability to start up a (endo) practice if i only find out a couple years from graduation that endo is what i really wanted to do and I was right all along.

So dam hard? Nothing worthwhile is easy. Give it a shot. A real shot, not just submitting an application.

 

[Longshot.308]

My background is as a general dentist for 5 years that just got accepted into an endo program.

There is no right or wrong choice here. However I cannot stress enough the difference between being a specialist and a gp that does a lot of endo. I certainly think that with a lot of CE and effort that you could become a GP that does high quality endo. However that is entirely different from being a specialist.
Here are a few big differences.

1. As a GP you will continue to have to provide a multitude of procedures. You might approach 30-35 percent of your practice doing endo but I anticipate that it would be hard to do more than that. Your still going to have to do lots of crowns, removable, implant restorations ect. Only as a specialist will you be able to do endo all day every day.

2. Hygiene- You will have to run a hygiene program as a gp and you will have to deal with hygiene checks all day.

3. Equipment- to do endo they way endodontists are going to do them your going to need a scope and a cone beam. I would recommend that you go to a gp office and an endodontists office and see the different setups. The endo office every room is going to be specifically geared toward endo. All your supplies, scopes ect ready to go in each room. At a gp office your setup is going to have to be entirely different. Endo typically has very low overhead. You will no be able to realize that low overhead potential as a GP because you will have all of the other services that you will have to offer and equipment that requires.

4. Treatment planning- As a gp you will have to do comprehensive exams and develop treatment plans. Many times this includes FMX, models ect. As an specialist you will primarily be focused on individual teeth.

5. Labs- you will constantly have to deal with labs as a gp. As a specialist you will not.

6. Patient interaction- As a GP you typically see patients many times over the years and build a relationship with them. This can be good for the good patients and a pain with bad patients. As a specialist you will see patients likely a few times and not build those same relationships.

7. As a specialist you referals will be the lifeblood of your practice. As a gp you will probably develop endo out of your own practice and have no referral interaction. Positives and negatives to both sides.


Like i said there is no right or wrong choice for you. The only thing I caution you on is to think that being a GP that does a lot of endo is similar to being an endodontist. Its just simply not the case and i am not talking about that quality of the work. As a specialist the staff your have, the equipment you have, the way your rooms are organized and the focus of what makes you money in the practice will be very different.

I would think about these things as you consider your plan. I would also seek out someone like myself but futher down the road. Find an endodontist who was a GP for a period of time and ask about there observations.

 

[DocJL]

To the OP's question: think long term. Where do you want to be 20 years out of school?

As a GP with almost 20 years experience, who was accepted into an endo program after being a GP for 8 years (4 years military, 4 years associate in private practive), but turned it down because with family obligations, etc, I couldn't see myself going back to school, (basically, I got cold feet at the last minute, lol) I understand where you are coming from.

FWIW, even though as a GP, solo private practice owner who now is mostly on auto-pilot, working 32-35 hours a week with my income in the top quartile of GP's (based on the ADA's surveys of income in private practice), I wish I had gone endo.

Why? to make really good money in general practice you have to really bust your butt, and see so many more patients. Also, a high income for a GP would be a low/average income for an endodontist. So if you were mostly interested in a good work/life balance you could work part time as an endodontist in a parternship or group, and still make considerably more than the "average" GP. An extra $100k or 200k or more income every year over a career makes a huge difference in quality of life for yourself and your family.

So my advice? If you are serious about specializing, do it early in your career, the longer you have "invested" in being a GP, the harder it is to go back to school, IMO.
Because by the time I applied and got it, I had a good comfort level, speed, income, etc as a GP, I was losing more in terms of "opportunity cost" by going back to school.