GPR or CE?

[PreDentRob]

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After I graduate dental school, I want to continue to learn as much as possible, gain maximum experience, and increase my skills and speed as quickly as possible before I purchase a practice.
I am debating between two ways to do it my first year out of dental school. I would love anyone's advice/opinion on this:

Option 1: Do a GPR. Obviously you could potentially waste a year of time or gain valuable clinical experience depending on the program you attend. Make around $40K.

Option 2: Get a job in private practice. Getting private practice clinical experience, but prob not doing as much comprehensive work as in a GPR. Start gaining exposure to the business side of dentistry. Make around $120K. I CAN SPEND $20-40K ON CE COURSES during my first year as a substitute for a GPR to increase my competency with implants and other comprehensive treatments, while still keeping more than twice as much $$ than I would be paid in a residency.

Option 2 seems like a wiser choice, but the main thing I'm unsure of is whether good CE courses can be a good enough substitute for the experience you can get in an AEGD/GPR?

 

[jk5177]

Be sure your option 2 is a real and not a fantasy, don't expect to make that much money if you are in a big urban area like SoCal or even NYC, but that amount does sound reasonable at more remote areas.

I'm assuming you've ruled out specialties as an option.

Also, AEGD/GPR can vary widely, some will give you implant experiences, and some won't at all. I don't know much about CEs.

 

[mike3kgt]

Make around $120K. I CAN SPEND $20-40K ON CE COURSES during my first year as a substitute for a GPR to increase my competency with implants and other comprehensive treatments

Your first figure is accurate, 120K is very reasonable in many places in the country.

Your second figure sounds like it could work, but let me tell you often times it does. In your first working positions or if you work as an associate you can make the figures, but the wiser approach would be to spend 10K MAX on CE during your first year and take that extra 10-20K and pay towards your loan principle.

You will NOT be competent after just one year of "advanced" training in practice. You will be barely scratching the surface of implant placement, comprehensive restorative dentistry etc. The comprehensive courses also take a significant time out of your schedule which makes the ability of making 120K more like 110K.

Now let's look at the REAL math

Say you live and work in California as a general dentist and your gross salary is quoted at 120K per year. Assume you are still single and claim no dependents for the IRS tax year of 2010. Also consider that you have no other federal allowances. Also assume that you are an associate that gets paid bi-weekly and have an average dental student loan of 200,000 locked in at 6.8% on a 30 year payment plan.

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Salary Paycheck Calculator
Your Pay Check Results

Bi-weekly Gross Pay = $4,615.38
Federal Withholding = $1,028.28
Social Security = $286.15
Medicare = $66.92
California = $374.12
CA SDI = $50.77
Net Pay (Biweekly) = $2,809.14

So in 2010, there are 27 pay cycles for the year based upon a bi-weekly pay schedule.

$2,809.14 x 27 = $75,846.78 (Total Net Pay)

--------------------------------

Let's look at expenses:

Loan Balance: $200,000.00
Adjusted Loan Balance: $200,000.00
Loan Interest Rate: 6.80%
Loan Fees: 0.00%
Loan Term: 30 years
Minimum Payment: $50.00

Monthly Loan Payment: $1,303.85
Number of Payments: 360

Cumulative Payments: $469,386.44
Total Interest Paid: $269,386.44

Total student loan paid for the year = $15,646.20

$75,846.78 Total Net - $15,646.20 Student Loans = $60,200.58 Total ($5,016.72 a month)

So say your living expenses are $2,000 a month for rent and utilities, $500 a month for groceries and dining and $500 for misc expenses/purchases/insurance that gives you a total of $2,016.72 left over a month.

So that's doing pretty well I'd say if you can save that much a month for trips and CE but that over the course of 12 months is $24,200.64 to play with. This is also considering you keep your groceries/dining/misc expenses down. Want a new car, well, add another $500 a month. Throw in a spouse/significant other/kids you can kiss a big chunk of the $24k goodbye.

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I'm not trying to be a debbie downer here, I'm just trying to tell you that advanced education in a dental school IS A GREAT DEAL if you are paid/stipend. It's just not realistic to think that you can spend so much on CE your first year. You also have to consider if your employer will pay for your malpractice insurance, dental fees and licenses etc.

If you can live like a student your first couple of years, you probably could spend 40K your first year on CE, but it's just not likely considering what most recent dental grads want in terms of lifestyle.

Education is critical, but seriously think about your future in terms of concrete numbers and sit down with a financial planner if you are unsure of your decisions.

Good luck!!

 

[PreDentRob]

My passion is for general dentistry, so I'm not interested in specializing. I also want to get into practice ownership as quickly as possible, but not before I'm really ready with enough experience to do it successfully!

Thanks for the calculations. I guess you could also take into account the 6 mo period that student loan payments are not required after graduating. But lets put finances on an equal playing ground. Meaning, after making student loan payments and paying about $20K for CE courses, I'm making the same as a residency stipend =prob ~$40K. (No financial advantage to either choice.)

Strictly comparing experience I could get in improving my skills, speed, business knowledge, etc and everything you would ideally want to gain before buying your own practice:

Option 1: GPR -> probably become more competent doing more kinds of comprehensive procedures. Prob get more "hands on" experience with comprehensive treatments than CE courses. (I will not have a high class ranking so lets just say this is an "average" GPR - not the best program nor the worst, but hopefully with at least some kind of experience with implants.)

Option 2: CE courses from experts in the field as apposed to instruction from a random instructor or other clinician. Gain experience in the real world in private practice. Probably increase speed more than I would in a GPR. Gain exposure to business side of dentistry. BTW- I heard Gordon Christensen's Practical Clinical Courses are 50% off to new grads, but even at full price these are about $2500 each for a 2 day course. Can get anything from OS to implants to cosmetics. Lets say I attended 5-6 such courses during my first year...
Just curious- Are CE courses also tax deductible business/education expenses?

Any opinions?

 

[HupHolland]

First of all Mike did a nice job of crunching the numbers. Just a side note: the market is not great now for new dentists. Many students from my school had a hard time finding work last year and had to compromise on pay and/or location. Many practice owners are seeking dentists with additional training making it that much harder for new grads to get jobs.

Now I'm only a 4th year dental student, no expert but here is my view about your scenario. I'm doing a gpr/aegd next year. I'm viewing the year as a transition year. Yes I will be taking a cut in pay (most programs I've interviewed at are paying between 45-50k), but I'm banking on the confidence and experience I gain will offset the pay cut. Its another year to work under an institution's umbrella to gain advanced training without worrying about getting sued / ruining my reputation in the community in which I practice. In my opinion you need more knowledge and experience than a fresh grad to get the most out of all this ce you plan on paying for.

Also unless the doc you're working for is a great mentor don't plan on learning a whole lot more than from your own mistakes.

Just my 2 cents,
Hup

My passion is for general dentistry, so I'm not interested in specializing. I also want to get into practice ownership as quickly as possible, but not before I'm really ready with enough experience to do it successfully!

Thanks for the calculations. I guess you could also take into account the 6 mo period that student loan payments are not required after graduating. But lets put finances on an equal playing ground. Meaning, after making student loan payments and paying about $20K for CE courses, I'm making the same as a residency stipend =prob ~$40K. (No financial advantage to either choice.)

Strictly comparing experience I could get in improving my skills, speed, business knowledge, etc and everything you would ideally want to gain before buying your own practice:

Option 1: GPR -> probably become more competent doing more kinds of comprehensive procedures. Prob get more "hands on" experience with comprehensive treatments than CE courses. (I will not have a high class ranking so lets just say this is an "average" GPR - not the best program nor the worst, but hopefully with at least some kind of experience with implants.)

Option 2: CE courses from experts in the field as apposed to instruction from a random instructor or other clinician. Gain experience in the real world in private practice. Probably increase speed more than I would in a GPR. Gain exposure to business side of dentistry. BTW- I heard Gordon Christensen's Practical Clinical Courses are 50% off to new grads, but even at full price these are about $2500 each for a 2 day course. Can get anything from OS to implants to cosmetics. Lets say I attended 5-6 such courses during my first year...
Just curious- Are CE courses also tax deductible business/education expenses?

Any opinions?

 

[setdoc7]

You have not factored in health insurance and disability insurance, which are both pricey and you cannot go without. Also, factor in malpractice and licensure fees as you cannot always expect an employer to pay for this. You will not be working in NY, as a GPR, AEGD, or other accredited residency is required.

 

[Mackchops]

Also unless the doc you're working for is a great mentor don't plan on learning a whole lot more than from your own mistakes.
Hup

Such an important and underrated point.

 

[PreDentRob]

First, I appreciate everyone's insights and welcome more.

Interesting point that CE's right out of dental school may not be as valuable since knowledge may be too low to grasp it all? Anyone else have an opinion on that?

Just a little more regarding my situation: I'm in Texas. From what I've heard, the market is a little better here, and I know of many dentists who have moved here in the last 1-2 yrs for that reason. Prob bc all the suburbs here are growing like crazy. I'm sure it can still be difficult to find a good job out of school though. Oh, and no state income tax 🙂

I don't graduate til 2014, so I'm hoping by then that the baby boomers are going to want to start looking for an associate in preparation for retirement. Since 3 dentists will be retiring for every 2 coming in during 2015-2020. Otherwise the chain/corporate dental clinics around here are starting new grads at $10-12,5K/mo, but working for those seem less preferable to me.

 

[mike3kgt]

I don't graduate til 2014....

...so I'm hoping by then that the baby boomers are going to want to start looking for an associate in preparation for retirement. Since 3 dentists will be retiring for every 2 coming in during 2015-2020.

Man, I feel like spending my time typing was a waste. Seriously, you are still a first year dental student... concentrate on learning the anatomy of a maxillary first molar now and start doing some serious life/number/professional info-crunching when you are at the end of your third year / the beginning of your first year.

And BTW, my personal experience is that the belief of the "more dentists are retiring than graduating so practices to buy are plentiful and associate positions are easy to find" is a myth. I plan on submitting it to mythbusters for testing. Seriously though, maybe that might be true in rural areas, but in desirable areas, practices and jobs are very tough to come by.

 

[PreDentRob]

You're answers aren't a waste because they're helping me out more than you think. You may not care to help a first year student, but I am serious about my future and care to learn everything I can as soon as I can.

I've seen lots of people who get into 4th year of DS and even graduate and then have an "oh crap" moment when they realize they have to find a job, buy a practice, etc. and they don't have to clue how to do most of it. Then are people (more rare) who by the time they get into fourth year of dental school, they have already researched and studied so much that they know where they're going, what they're doing and how to do it. When they graduate they know where they want to practice because they've studied all the demographics and talked to lots of people. They've already been reading books on how to start/buy/manage a dental practice, asking questions to everyone they talk to, studying, and planning and so they have their business model ready to go and know how to run it. I happen to be one of these types.

Not only that, the earlier I can decide what I'm going to do can give me a much clearer purpose to the rest of my education the next couple years. For example, because of all the time I've put into learning about what it's like to work in each facet of dentistry, I've been able to figure out going into D-School that GP is the best fit for me, which is allowing me to focus on actually learning things that matter (like the anatomy of a first molar) and worry less about memorizing the histology of the duodenum because I'm not stressing over grades. Can you wait til later to start figuring out what you're going to do and still be okay? Obviously. But I don't think you can ever learn too much too early.

I am aware of the potential debate over next decade's projections on number of retirees vs incoming dentists, esp with so many new dental schools popping up.

But having said all that, I hope to keep this forum focused on the original questions at hand...

 

[MDMD11]

You can learn so much associating vs jumping into private practice purchasing!! You can even learn a thing or two from running a practice from the guys/gals that have a few grey hair....that I say take it one day at a time and worry about buying where/what closer to when you have the skill set. Dental school gives you the bare minimum in terms of experience and depth of complex treatments and your DDS/DMD doesnt mean you can place implants first week out of school 🙂 just my two scents though

 

[PreDentRob]

You can learn so much associating vs jumping into private practice purchasing!! You can even learn a thing or two from running a practice from the guys/gals that have a few grey hair....that I say take it one day at a time and worry about buying where/what closer to when you have the skill set. Dental school gives you the bare minimum in terms of experience and depth of complex treatments and your DDS/DMD doesnt mean you can place implants first week out of school 🙂 just my two scents though

That's exactly what I think/hope, and one of the reasons I mentioned that lead me to wonder if there can be just as much value in an extra year as an associate instead of in a residency. I don't imagine myself purchasing a practice for AT LEAST 2-3 years after school. I just want to learn as much as I can in the meantime, so when the time comes, I'm as ready as possible.

If anyone else has any opinions, I would love to hear more on whether you think it's possible to get just as valuable experience associating and attending several CE courses first year or two out of school instead of doing a GPR? Or is there no substitute for a GPR? Will one route or the other better prepare you for practice ownership?

 

[HupHolland]

That's exactly what I think/hope, and one of the reasons I mentioned that lead me to wonder if there can be just as much value in an extra year as an associate instead of in a residency. I don't imagine myself purchasing a practice for AT LEAST 2-3 years after school. I just want to learn as much as I can in the meantime, so when the time comes, I'm as ready as possible.

If anyone else has any opinions, I would love to hear more on whether you think it's possible to get just as valuable experience associating and attending several CE courses first year or two out of school instead of doing a GPR? Or is there no substitute for a GPR? Will one route or the other better prepare you for practice ownership?

YES, it is possible to get valuable experience during an associateship + taking CE courses. In GENERAL, do I think this experience is more valuable than doing a (good!) 1 year GPR/AEGD? No. Your advanced education will allow you to "test the waters," so to speak. You will get to get your feet wet doing more advanced procedures such as perio surgery, implant placement and impaction exodontia. You may be taking call at a hospital, seeing emergencies in the middle of the night, possibly suturing a lip, doing an I&D or splinting teeth. You will feel uncomfortable at the time, but in the end you will be confident seeing anything.

I'm speaking for Maryland, not Texas. It is very tough for new grads to find good jobs here in the DC/Baltimore area. The new guys that are doing well have moved out to the mountains (i.e. rural area). Most docs are looking for those with advanced education. It's becoming the standard in the state.

Also, as I stated before. All associateships aren't created equal. If you're working for your mother/father, then you will have a much better experience than working for a guy listed on craigslist.

In the end, you have the rest of your life to practice in private practice. You will never go back and do a GPR/AEGD after entering the private sector, however.

Hup

 

[PreDentRob]

YES, it is possible to get valuable experience during an associateship + taking CE courses. In GENERAL, do I think this experience is more valuable than doing a (good!) 1 year GPR/AEGD? No. Your advanced education will allow you to "test the waters," so to speak. You will get to get your feet wet doing more advanced procedures such as perio surgery, implant placement and impaction exodontia. You may be taking call at a hospital, seeing emergencies in the middle of the night, possibly suturing a lip, doing an I&D or splinting teeth. You will feel uncomfortable at the time, but in the end you will be confident seeing anything.
...
In the end, you have the rest of your life to practice in private practice. You will never go back and do a GPR/AEGD after entering the private sector, however.

Hup

Thanks Hup, Good input.

 

[DentalDamnIt]

here's my take
1) gpr is the way to go, if you find the right program.

-i did 30+ implants, restored 20 of 'em, implant supported over dentures, 3rds, IV sedations, N20 sedation, pedo, ortho, molar endo with scopes, OR, etc etc. you aint gonna find that in CE or an associateship. GPR is a learning environment, directors know that, faculty know that, and more importantly pts know that too.
-this year is private practice: crown bridge fills hygiene some anterior rcts

2) associateship and mentor is great, if you can find the right one.

but who is gonna take the time out to teach you. they running a business. they in it to make money and they expect you to do the same. make them money. so learning during the associateship.... it's secondary to production and the profit. unless the DMD is a friend, dad/mom, etc. you know. your mentor is paying you to work. s/he is not paying you to learn. they'll show you some 'tricks', some insurance things, some materials, some of this, some of that.... but is it a whole course on this or that? prob not...... is it the right way, the evidence-based way?.... maybe, maybe not. gpr usually do things by the book. youstart to learn 'bad' habits early.... its hard to unlearn 'em later.

3) CEs:

hard to do clinical CE w/o actual pts. in my opinion. i rather be doing it on real pts rather than on pig jaws and extracted molars. my boss has taken countless CE on implants.... he's placed one. no plans to doing it in the future. he's too scared to tx plan and 'experiment' on his own pts. plus many are on thurs and fri, which means taking a day or two off, which means you don't get paid on those days.

4) dental schools don't teach you jack to just go out and practice. maybe for some. but my hands suck. can't even draw a circle with a pencil... so i needed the extra time to doing dentistry the right way.

@mike: dude the numbers didn't go to waste man. eye opening for me to see! jesus i gotta work more! hahaha

 

[zriceman]

here's my take
1) gpr is the way to go, if you find the right program.

-i did 30+ implants, restored 20 of 'em, implant supported over dentures, 3rds, IV sedations, N20 sedation, pedo, ortho, molar endo with scopes, OR, etc etc. you aint gonna find that in CE or an associateship. GPR is a learning environment, directors know that, faculty know that, and more importantly pts know that too.
-this year is private practice: crown bridge fills hygiene some anterior rcts

2) associateship and mentor is great, if you can find the right one.

but who is gonna take the time out to teach you. they running a business. they in it to make money and they expect you to do the same. make them money. so learning during the associateship.... it's secondary to production and the profit. unless the DMD is a friend, dad/mom, etc. you know. your mentor is paying you to work. s/he is not paying you to learn. they'll show you some 'tricks', some insurance things, some materials, some of this, some of that.... but is it a whole course on this or that? prob not...... is it the right way, the evidence-based way?.... maybe, maybe not. gpr usually do things by the book. youstart to learn 'bad' habits early.... its hard to unlearn 'em later.

3) CEs:

hard to do clinical CE w/o actual pts. in my opinion. i rather be doing it on real pts rather than on pig jaws and extracted molars. my boss has taken countless CE on implants.... he's placed one. no plans to doing it in the future. he's too scared to tx plan and 'experiment' on his own pts. plus many are on thurs and fri, which means taking a day or two off, which means you don't get paid on those days.

4) dental schools don't teach you jack to just go out and practice. maybe for some. but my hands suck. can't even draw a circle with a pencil... so i needed the extra time to doing dentistry the right way.

@mike: dude the numbers didn't go to waste man. eye opening for me to see! jesus i gotta work more! hahaha

Which GPR did you attend?

 

[ChiLax]

Man, I feel like spending my time typing was a waste. Seriously, you are still a first year dental student... concentrate on learning the anatomy of a maxillary first molar now and start doing some serious life/number/professional info-crunching when you are at the end of your third year / the beginning of your first year.

Thats funny. 1st year student? I think he needs a wild woman and a bottle of whiskey. Good for him for being so planning aheadish, but wow. I'm in my last semester of school and the only thing i really care about is requirements, part II, and the WREB....Bond and Netflix for Wii is pretty good too. So in summary to the OP: woman, whiskey, Wii, study.

 

[PreDentRob]

Yes, there are varying degrees of motivation among the human race. And thus, varying degrees of success too. But I have no disrespect for either side of the spectrum.

Thanks to those who have contributed valuable answers to my questions.

 

[CODDS]

I've been out for 8 years, and did not have a good GPR experience. On the other hand the spectum of quality CE is all over the place. Manufact's push products at many CE courses and they are not always good products in the best int. of our patients. So, either way you need to be selective. Life is short, don't settle for convenient GPR's or CE's that will utlimately waste your time. Choose CE sponsored through organizations such as the AAID or a College Based program.

 

[DentalDamnIt]

Which GPR did you attend?

unr