GRAD PROS?

[CowboyCanine]

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I am preparing to apply to a Grad Pros program soon.
I keep hearing about the pros and cons of grad pros program

Do you think it is worth it financially?

 

[TanMan]

I am preparing to apply to a Grad Pros program soon.
I keep hearing about the pros and cons of grad pros program

Do you think it is worth it financially?

No. (I'll go on more about it later today by editing this post or replying again)

 

[Ximilara]

No. (I'll go on more about it later today by editing this post or replying again)

May I ask what if the program has stipend(VA hospitals etc..), is it worth to go?

 

[TanMan]

Still no... you're forgoing potential GP income for 3 years. The stipend might compensate for some of the difference, but the 3 year difference in lifetime aggregate income and the potential to make less than a GP with more headaches than the traditional GP seem to be a lose-lose situation.

This individual claims to own a solo GP practice that supposedly produces 2M+/year with the goal of early retirement. To him/her, any more schooling beyond the traditional 4-year dental school is not worth the cost. His/her hedonistic life philosophy can be summarized in "I work to live not live to work."

Yep... I don't see why anyone would not want to pursue that life philosophy.

I don't think it's worth financially (or any other legitimate reason besides loving prosthodontics) for the following reasons:

1. 3 years... That's a long time for something that GP's can take on by doing comprehensive CE's with those Dawson, Spear, Kois institutes, etc... If you're looking to do comprehensive reconstruction cases, you can still do them and take those CE's on the side.
2. Patient perception of prosthodontists. If a patient asks what you do, and you talk about full mouth reconstruction, crowns, bridges, partials, implants, etc... patients ask, don't all dentists do that?
3. If you choose to be a referral-based prosthodontist, you will get the worst patients clinically and mentally. There's a reason patients are referred to prosth. Either patient is unstable that GP cannot meet expectations and you will be forced to take them on, or the case is so far gone that you will be stuck with more difficult cases that may or may not be worth your time. You might be able to charge more, but proportionally, you'll put in more time.

I remember an ad that a prosthodontist put out regarding GP's vs prosthodontists. Did not sit very well with the GP's.

Personally, I don't think it's worth it. If you want to do what a prosthodontist does, take a long-term CE course to build up your skills. I don't like the headache, so I focus on small cases.

Edit: I've replied to the OP via PM.

 

[321931]

I am preparing to apply to a Grad Pros program soon.
I keep hearing about the pros and cons of grad pros program

Do you think it is worth it financially?

Not many people can financially afford a prosthodontist.

Prosthodontist tend to be established in an area and breaking into the area is hard. However once established and reputation is gained- prosthodontists can be very profitable.

Deals with very complex cases and or complex patients. This month I referred out 6000$ worth of 6-11 crowns because the patient is super picky talking about length, shape, incisors, whatever. Until you have worked on these patients- you have no clue how emotionally draining these kind of people are. Have fun with 3-4 try-ins and or possibly cementing them in and then having them come back and say they are to white dark or brown and having to redo them again. Seriously by the time you are done with one of these headache cases...you will learn that it isn't worth your sanity and time and effort.

Much easier being a GP doing fill and drill dentistry.

Regardless of everything being said, money should be an afterthought. Business puts everyone on equal footing and the thought that if I specialize=more money isn't the correct answer at all. It should be looked at time spent in education = potential lost opportunity cost. 2-3 years of accumulating more debt on top of interest is rough. Could easily buy/startup a practice and make good money paying back loans, and taking advanced CE courses that will put you on par as a prosthodontist.

But to each his own- there is no right or wrong answer. If challenging cases excite you- then go for it. I have zero interest in 6-11 cosmetic work and all on 4 dentures etc, and most of all I have ZERO interest in dealing with headache patients...which prosthodontists get all the time.

 

[BocasDelToro]

His/her hedonistic life philosophy can be summarized in "I work to live not live to work."

There is utterly nothing wrong with this philosophy. Working hard in a career in order to enjoy life shouldn't be frowned upon, it should be the goal. Unless you're like really, really into teeth or something

 

[321931]

That is the point of specializing though, which is to see less patients and provide higher quality dentistry all the while charging a higher fee. I don't see why you keep bringing up less patient volume for high-end dentistry as a con for specializing when that is actually an upside. Not everyone wants to set up a mom and pop dental shop doing crowns and fills all day. For some, it is about achieving the highest level of excellence in a narrow area of a profession and deriving professional satisfaction from high quality work.

Two words: insurance, and commodity. You will understand when you graduate and work. Day in and day out. It's the same and getting worse. What does my insurance cover, how much it costs, and I don't want to do it because its to expensive. Dentistry is heading that way. If you can carve a niche where people appreciate high quality work paying 10's of thousands of dollars for work, then more power to you, but it ain't heading that way in my opinion. Good luck.

 

[321931]

Carving out a niche in dentistry is called specializing. Insurance for GP isn't the same as that for specialists.

I agree with what you stated. I will contest that- Specializing in perio, endo, omfs, pedo is carving a niche because technically alot of GP's cannot do the same as what they do.

Prosth- as stated by Tanman- sorta borderlines the area of what a GP with alot of CE can do. So the niche/moat is sorta minimal. Two cases that I referred out to prosthodontist back in January all came back stating "send my xrays to GP #45032251"- the one that advertises 59.99$ cleanings with free sonicares" because they just didn't want to pay up specialist price and according to GP #45032251- they can do 6-11 crowns no problem.

In my opinion, Prosthodontists are effectively a FFS dentist because their fees are so expensive. People don't want to pay for expensive treatment, they want cheap/in network treatment, and will effectively seek out a GP that can do the similar type of treatment. With all that being said I reiterate: "Prosthodontist tend to be established in an area and breaking into the area is hard. However once established and reputation is gained- prosthodontists can be very profitable." So there will be people that will value prosth work, but as dentistry is continuing to become more and more of a commodity, it will be harder to convince patients to see the value in expensive dental work- and as GP's become more and more of SUPER GP's because of increased competition- the moat/niche carved will become less apparent. That being said, there is def a need for prosthodontists cuz lazy dentists like me have no interest in cosmetic full mouth reconstruction and or all on four dentures etc.

 

[Svart Aske]

I am in a similar boat and considering applying to prostho programs.

Just to echo what everybody said. Don't do it for the money. I want to do it because I'm getting bored of drill and fill dentistry and want to advance my knowledge and skills in complex treatments. There's a lot of professional satisfaction in being able to plan and execute treatment well. And I won't lie, a big part of it is probably Ego.

You can certainly practice at a very high level (better than most specialists) as a GP if you are dedicated to lifelong learning and perfecting your skills. But in my opinion it's a much longer and nebulous road to get to that point. You'll be dropping tens to hundreds of thousands on CE, hours reading literature and many failed cases and unsatisfied patients along your journey.

The benefits of a formal residency is the complete immersion in a field, actual clinical experience on patients (not typodonts like at CE courses), working directly with other specialists, and being able to learn from your mistakes and not worry about getting sued.

 

[TanMan]

Carving out a niche in dentistry is called specializing. Insurance for GP isn't the same as that for specialists.

Specialists will always be needed, with or without insurance.

I agree with what you stated. I will contest that- Specializing in perio, endo, omfs, pedo is carving a niche because technically alot of GP's cannot do the same as what they do.

Prosth- as stated by Tanman- sorta borderlines the area of what a GP with alot of CE can do. So the niche/moat is sorta minimal. Two cases that I referred out to prosthodontist back in January all came back stating "send my xrays to GP #45032251"- the one that advertises 59.99$ cleanings with free sonicares" because they just didn't want to pay up specialist price and according to GP #45032251- they can do 6-11 crowns no problem.

In my opinion, Prosthodontists are effectively a FFS dentist because their fees are so expensive. People don't want to pay for expensive treatment, they want cheap/in network treatment, and will effectively seek out a GP that can do the similar type of treatment. With all that being said I reiterate: "Prosthodontist tend to be established in an area and breaking into the area is hard. However once established and reputation is gained- prosthodontists can be very profitable." So there will be people that will value prosth work, but as dentistry is continuing to become more and more of a commodity, it will be harder to convince patients to see the value in expensive dental work- and as GP's become more and more of SUPER GP's because of increased competition- the moat/niche carved will become less apparent. That being said, there is def a need for prosthodontists cuz lazy dentists like me have no interest in cosmetic full mouth reconstruction and or all on four dentures etc.

There will definitely always be a need for prosthodontists. Just that the market forces are not friendly to prosthodontists, especially for the BS they have to put up with.

I am in a similar boat and considering applying to prostho programs.

Just to echo what everybody said. Don't do it for the money. I want to do it because I'm getting bored of drill and fill dentistry and want to advance my knowledge and skills in complex treatments. There's a lot of professional satisfaction in being able to plan and execute treatment well. And I won't lie, a big part of it is probably Ego.

You can certainly practice at a very high level (better than most specialists) as a GP if you are dedicated to lifelong learning and perfecting your skills. But in my opinion it's a much longer and nebulous road to get to that point. You'll be dropping tens to hundreds of thousands on CE, hours reading literature and many failed cases and unsatisfied patients along your journey.

The benefits of a formal residency is the complete immersion in a field, actual clinical experience on patients (not typodonts like at CE courses), working directly with other specialists, and being able to learn from your mistakes and not worry about getting sued.

What he said (in bold)... You don't do it for the money, you want to be able to plan and execute complex treatments well. The only thing I don't agree on is that completing a residency suddenly makes you god's gift to that particular field of dentistry. The residency gives you a strong foundation to become a great lifelong provider and clinician (in theory). I've seen some terrible specialists as well, but on average, specialists practice at a higher level.

Also, being a resident doesn't make you immune from getting sued. You will mess up somewhere in your lifetime and it will be on patients.

 

[CowboyCanine]

Thank you all for taking the time to reply. It seems people are split on the subject- those that say it is worth it, and those that prefer to just go to CEs and keep working as GPs

It appears a lot of pros people seem to have not make as much initially, as the overhead is one of the highest in all of dentistry (60-70%, depending on who you talk to). Some recent grads are even working as Super GPs for corporate chains

I have talked to others that say, with the right marketing (!!!!!!! which could mean a lot of things), prosthodontic practices can be a good money making venture

I know I have focused on the financial aspect a lot with this post. Regarding being " passionate and doing what you love ", I KNOW I would enjoy the field. However, I also have very real student debt , and this is a sobering reality. If I go to school for three years (loss of income) and end up making 130K, it would be a tragic situation.

This is what is confusing me, as everyone has a different opinion. I am not looking to make 500K right out of school (which would be kinda nice heheh).

Do you know any prosthodontists that have very successful practices?

 

[321931]

Thank you all for taking the time to reply. It seems people are split on the subject- those that say it is worth it, and those that prefer to just go to CEs and keep working as GPs

It appears a lot of pros people seem to have not make as much initially, as the overhead is one of the highest in all of dentistry (60-70%, depending on who you talk to). Some recent grads are even working as Super GPs for corporate chains

I have talked to others that say, with the right marketing (!!!!!!! which could mean a lot of things), prosthodontic practices can be a good money making venture

I know I have focused on the financial aspect a lot with this post. Regarding being " passionate and doing what you love ", I KNOW I would enjoy the field. However, I also have very real student debt , and this is a sobering reality. If I go to school for three years (loss of income) and end up making 130K, it would be a tragic situation.

This is what is confusing me, as everyone has a different opinion. I am not looking to make 500K right out of school (which would be kinda nice heheh).

Do you know any prosthodontists that have very successful practices?

The prosthodontists that I refer to are very well established and are successful because they have built up their reputation as “the” prosthodontist. However my current office manager worked for two prosthodontists... and we collect more then them as a normal GP practice. Granted it’s a small sample size...

Anyways, She says the big money is in OMFS- she worked for a few OMFS- But that’s an aside.

You could always work your way into the neighborhood- granted there isn’t any big prosthodontist in town- and become “that guy.”

So the bottom line I guess is don’t do it for the money. You can make just as much as a GP owner. Do it because you have interest in full mouth recon, dentures and dealing with pain in the butt patients that GPS will refer you. Some people honestly like converting angry or needy patients to happy patients. You will get referalls from GPs for single unit crowns... and ask yourself why is GP referring a single unit crown... and then you will meet the patient and see tons of red flags.

So all in all your question about “successful” practice is sorta a moot point.

 

[sb.tnh]

If a specialist chooses to practice as a super GP, do they have to permanently renounce their specialty? Can they temporarily renounce it and switch back to being a specialist later?

 

[321931]

If a specialist chooses to practice as a super GP, do they have to permanently renounce their specialty? Can they temporarily renounce it and switch back to being a specialist later?

Specialists count on referalls to build their practice. If you renounce your title, you won’t get GP referalls. You could theoretically survive as a Prosthodontist ... not so much as a pedo/perio/omfs/ortho. But that being said if I heard of a specialist in my area pulling that trick as stated, I wouldn’t ever refer to them. Plus there’s enogh specialists in every area that I can just find someone not doing that and refer to them. In my area we have 5-10 of every specialist in the area. Only 2-3 prosthodontists though. Just my 2 cents.

 

[schmoob]

If a specialist chooses to practice as a super GP, do they have to permanently renounce their specialty? Can they temporarily renounce it and switch back to being a specialist later?

A specialist wont practice as a super GP because they're not super GP's. They've only been focusing on their specialty.

 

[deleted659902]

RE: semantics of "super" GPs

The only specialists that can claim the title of "super" GPs are those who went to UT San Antonio or UPenn's combined perio-prosth training program.

 

[TanMan]

RE: semantics of "super" GPs

The only specialists that can claim the title of "super" GPs are those who went to UT San Antonio or UPenn's combined perio-prosth training program.

In school, they called them "bulletproof specialists/GP's". I think it requires a "special" kind of person to go into a program like that. People who tend to go into perio OR prosth tend to be more anal. I can only imagine people who do BOTH.

If a specialist chooses to practice as a super GP, do they have to permanently renounce their specialty? Can they temporarily renounce it and switch back to being a specialist later?

Specialists who do that, especially those that take other GP's patients and start perform work outside of their specialty, get burned real quickly on referrals. There are some specialties that can get away with that more readily than others. However, it requires an aggressive direct marketing campaign.

 

[periopocket]

I am sure for training purposes, its excellent - all depends on your end goal and if you want a strictly referral based practice or you want to market to the public and be in direct competition with GP, Perio and OMS.

 

[BellaNella]

RE: semantics of "super" GPs

The only specialists that can claim the title of "super" GPs are those who went to UT San Antonio or UPenn's combined perio-prosth training program.

After completing a program like this, I doubt that one would want to claim that title

 

[CowboyCanine]

In school, they called them "bulletproof specialists/GP's". I think it requires a "special" kind of person to go into a program like that. People who tend to go into perio OR prosth tend to be more anal. I can only imagine people who do BOTH.



Specialists who do that, especially those that take other GP's patients and start perform work outside of their specialty, get burned real quickly on referrals. There are some specialties that can get away with that more readily than others. However, it requires an aggressive direct marketing campaign.

I think you are right about the burning the referral quickly.

However, I have talked to a few prosthodontists. What I gathered from these conversations is that there are very few referral based practices that are highly successful. That used to be a thing of the past where you would graduate, open up shop and hope to get referrals.

Apparently, most pros people need 4-5 years to make a"name " for themselves, and prior to that, they practice mostly general dentist, with advanced care, and difficult cases that is referred by others. Some General dentist do not refer to them in a short term, but with time as they have the training to tackle tough cases (read difficult denture patients no one wants). Some go around local study clubs, give lectures, etc to get their names out, and build their bases, and fine tune it to the type of specialty practice they want.

Also, I have been told that most younger dentist graduating seem to refer multiple implant cases, immediate denture cases and implant supported denture cases to prosthodontist

 

[TanMan]

I think you are right about the burning the referral quickly.

However, I have talked to a few prosthodontists. What I gathered from these conversations is that there are very few referral based practices that are highly successful. That used to be a thing of the past where you would graduate, open up shop and hope to get referrals.

Apparently, most pros people need 4-5 years to make a"name " for themselves, and prior to that, they practice mostly general dentist, with advanced care, and difficult cases that is referred by others. Some General dentist do not refer to them in a short term, but with time as they have the training to tackle tough cases (read difficult denture patients no one wants). Some go around local study clubs, give lectures, etc to get their names out, and build their bases, and fine tune it to the type of specialty practice they want.

Also, I have been told that most younger dentist graduating seem to refer multiple implant cases, immediate denture cases and implant supported denture cases to prosthodontist

I have talked to others that say, with the right marketing (!!!!!!! which could mean a lot of things), prosthodontic practices can be a good money making venture

The question would then be... why would you want to wait 4-5 years to make a name for yourself, when you can do that as a GP w/o prosth training. Things that you have mentioned can be done as a GP with extensive marketing, without the 3 years of additional training. Being a prosthodontist attracts the worst patients via self-referral (they think/know you're the best/better than a GP and expect the best/unrealistic results) and referral from GP's. I think a 3 year headstart as a GP would make more financial sense, rather than the slow ramping up as a prosthodontist or practicing as a GP (delayed start).

I am so glad I don't do any removables... these patients usually have one problem or another, even with an implant assisted/supported prosthesis. I don't do removables because they require a lot of time, patience, and the demographic tends to have more time to burn than you. Multiple implant cases are not difficult; once you start to get into the all on X's that the production/hour ratio tapers or drops. I'd rather do 8 single unit implants (or FPD's) and get 25-30k for it than do a single arch of an all on X for 25-50k each. You don't need verification jigs, try-ins, etc... with a few units.

Why make more work for yourself when you can take the easier path.

 

[TanMan]

Among many reasons, an ego/pride is a big one. Even these big, challenging, and time consuming cases become easier and routine with time. Going for extra training definitely takes emotional maturity and knowing what you want in life.

I can see how ego/pride would play a role, but I don't know about the emotional maturity needed to go for extra training. Sounds like tortuous hell to me. Time is not on my side, but I guess if you want to practice in your 50's, then time is your friend. Reminds me of Calvin and Hobbes and doing things you hate to do "builds character".

 

[P7898]

I can see how ego/pride would play a role, but I don't know about the emotional maturity needed to go for extra training. Sounds like tortuous hell to me. Time is not on my side, but I guess if you want to practice in your 50's, then time is your friend. Reminds me of Calvin and Hobbes and doing things you hate to do "builds character".

TanMan, what would be the timeline for a student going into prosthodontics versus someone who takes the CE for these procedures. I think there are the pros of doing all the training up front

The question would then be... why would you want to wait 4-5 years to make a name for yourself, when you can do that as a GP w/o prosth training. Things that you have mentioned can be done as a GP with extensive marketing, without the 3 years of additional training. Being a prosthodontist attracts the worst patients via self-referral (they think/know you're the best/better than a GP and expect the best/unrealistic results) and referral from GP's. I think a 3 year headstart as a GP would make more financial sense, rather than the slow ramping up as a prosthodontist or practicing as a GP (delayed start).

I am so glad I don't do any removables... these patients usually have one problem or another, even with an implant assisted/supported prosthesis. I don't do removables because they require a lot of time, patience, and the demographic tends to have more time to burn than you. Multiple implant cases are not difficult; once you start to get into the all on X's that the production/hour ratio tapers or drops. I'd rather do 8 single unit implants (or FPD's) and get 25-30k for it than do a single arch of an all on X for 25-50k each. You don't need verification jigs, try-ins, etc... with a few units.

Why make more work for yourself when you can take the easier path.

TanMan, what would be the timeline for someone who wanted to limit their practice to a more "cosmetic focus" by doing a prosthodontics route versus a GP doing an AEGD/taking CE courses. I think some people view the prosth route as getting in the training now so later on in their profession they are striving versus frantically searching for the best CE. There are obvious opportunity costs for both routes.

What are your thoughts? I know some people that would like to knock it all out of the way versus others that go the CE route.

 

[Svart Aske]

I know some people that would like to knock it all out of the way versus others that go the CE route.

Despite what people tell you, no amount of weekend CE and hands-on training on typodonts can replace the experience and learning from actually treating complex cases under supervision in a formal residency.

 

[TanMan]

TanMan, what would be the timeline for a student going into prosthodontics versus someone who takes the CE for these procedures. I think there are the pros of doing all the training up front


TanMan, what would be the timeline for someone who wanted to limit their practice to a more "cosmetic focus" by doing a prosthodontics route versus a GP doing an AEGD/taking CE courses. I think some people view the prosth route as getting in the training now so later on in their profession they are striving versus frantically searching for the best CE. There are obvious opportunity costs for both routes.

What are your thoughts? I know some people that would like to knock it all out of the way versus others that go the CE route.

In restorative dentistry/prosthodontics, there are many different clinical philsophies, not just in prosthodontic programs, but also CE courses. When you sign up for a residency program or set of CE courses to learn FMR, you are subscribing to their particular brand of clinical practice. Finishing a whole series of CE courses or a residency doesn't mean that you are done. In fact, it is only the beginning of your career-long (hopefully not lifelong) journey. As there are strong/weak prosthodontic programs, I am sure there are strong/weak CE programs as well.

I'm an advocate of doing more than just what a specialty can limit you; If I were to place 28 crowns and I had to do 10 endos, I'd like the option to do the endos, CL, osseous surgery, etc... That's the advantage of doing CE and working in private practice simultaneously. You practice the way you want to practice and make way more money with less restrictions on your autonomy. The only questionable aspect is that your first cases that you are implementing your knowledge on, are pretty much your guinea pigs. However, the same can be said about a residency (although you have a faculty member backing you up), if you have a good friend or paid a prosthodontist to fix what you've messed up, it's essentially the same thing. I guess what to choose all depends on your learning style. If you like to take a course, implement what you've learned and learn from your mistakes as you go (and make more money in the end), then private practice + CE is the way to go. If you prefer to have a more structured learning environment with more variables under control in the academic setting, then go to a residency.

Now, for the timeline. The timeline depends on the length of the residency program v. CE courses (series). Why would you need to be stuck in an academic setting the whole time unless you're allowed to moonlight, make money on the side, AND implement what you're learning, then that makes a lot more sense. Unless, of course, you're stuck doing labwork or non-productive procedures that a DA/CDT/MDT/MDC can perform.

If you want to focus on cosmetics, there are plenty of CE courses out there that cover from photography all the way stacking your own porcelain. You don't need a prosthodontics program to do cosmetic dentistry. IIRC, there are some cosmetic dentistry residencies, but I'm not sure if there are still any operating at this time. I had an opportunity to work with a few of the residents in dental school. You must really love cosmetic dentistry to dedicate that much time into it. It's almost an obsession (but in a good way, if you enjoy it).

I like the CE route if I had to choose. I have the ability to learn in progression, without taking a bunch of my time, apply what I'm learning in my own practice after that session is over and in the context of owning/running a practice. You have a front row seat of seeing what works and doesn't work in the real world. In a residency, it's more insulated.

 

[P7898]

In restorative dentistry/prosthodontics, there are many different clinical philsophies, not just in prosthodontic programs, but also CE courses. When you sign up for a residency program or set of CE courses to learn FMR, you are subscribing to their particular brand of clinical practice. Finishing a whole series of CE courses or a residency doesn't mean that you are done. In fact, it is only the beginning of your career-long (hopefully not lifelong) journey. As there are strong/weak prosthodontic programs, I am sure there are strong/weak CE programs as well.

I'm an advocate of doing more than just what a specialty can limit you; If I were to place 28 crowns and I had to do 10 endos, I'd like the option to do the endos, CL, osseous surgery, etc... That's the advantage of doing CE and working in private practice simultaneously. You practice the way you want to practice and make way more money with less restrictions on your autonomy. The only questionable aspect is that your first cases that you are implementing your knowledge on, are pretty much your guinea pigs. However, the same can be said about a residency (although you have a faculty member backing you up), if you have a good friend or paid a prosthodontist to fix what you've messed up, it's essentially the same thing. I guess what to choose all depends on your learning style. If you like to take a course, implement what you've learned and learn from your mistakes as you go (and make more money in the end), then private practice + CE is the way to go. If you prefer to have a more structured learning environment with more variables under control in the academic setting, then go to a residency.

Now, for the timeline. The timeline depends on the length of the residency program v. CE courses (series). Why would you need to be stuck in an academic setting the whole time unless you're allowed to moonlight, make money on the side, AND implement what you're learning, then that makes a lot more sense. Unless, of course, you're stuck doing labwork or non-productive procedures that a DA/CDT/MDT/MDC can perform.

If you want to focus on cosmetics, there are plenty of CE courses out there that cover from photography all the way stacking your own porcelain. You don't need a prosthodontics program to do cosmetic dentistry. IIRC, there are some cosmetic dentistry residencies, but I'm not sure if there are still any operating at this time. I had an opportunity to work with a few of the residents in dental school. You must really love cosmetic dentistry to dedicate that much time into it. It's almost an obsession (but in a good way, if you enjoy it).

I like the CE route if I had to choose. I have the ability to learn in progression, without taking a bunch of my time, apply what I'm learning in my own practice after that session is over and in the context of owning/running a practice. You have a front row seat of seeing what works and doesn't work in the real world. In a residency, it's more insulated.

Great post and appreciate the real world applications. Makes students like me see this from a different lens. I was more wondering about the length of CE over a durations of years to get to a skilled level when compared to a prosthodontist that undergoes those 3 years of training. It seems like it would take 5-10 years of CE to get to that level.

 

[TanMan]

It would be best to ask someone who has done the CE route v. prosthodontic residency route. I can give you the perspective of a GP in the context of GP profitability, but I would think that time spent on CE v. residency isn't necessarily 1 to 1 either. I would not be able to say if doing a weekend or two every month for 2 years is equivalent to a residency, but I like the idea that I'm making money, practicing in the real world going the CE route, and able to immediately put what I've learned into the private practice context right after the course.

Altogether, I'm not a fan of residency unless you absolutely love the field, only want to practice in that field for the rest of your life, and willing to give up a few more years of your prime years to pursue that specialty. Even dental school felt too long.

 

[321931]

TanMan, what would be the timeline for a student going into prosthodontics versus someone who takes the CE for these procedures. I think there are the pros of doing all the training up front


TanMan, what would be the timeline for someone who wanted to limit their practice to a more "cosmetic focus" by doing a prosthodontics route versus a GP doing an AEGD/taking CE courses. I think some people view the prosth route as getting in the training now so later on in their profession they are striving versus frantically searching for the best CE. There are obvious opportunity costs for both routes.

What are your thoughts? I know some people that would like to knock it all out of the way versus others that go the CE route.

Cosmetic focused dentists are a whole nother ballpark of dentistry. You see cosmetic dentists....market themselves as cosmetic dentists. While prosthodontists market themselves as "full mouth rehabilitation and or cosmetic dentists." The top three cosmetic dentists in my area are all...general practitioners. But they market themselves as THE cosmetic dentist.

Go type in Beverly Hills Cosmetic Dentist. The top three results are all General Dentists that have taken CE to do cosmetic work.

You don't have to search frantically. There are really only 2-3 courses for extensive cosmetic CE. Dawson, Spears, LVI, and a few others. It's not rocket science. The results on these CE courses are good but they are pricey.

The benefit of what Tanman is saying is that the lost opportunity cost of training, while loans are accumulating interest means that in the long run you are losing out compared to a GP owning his own practice and accumulating CE as they go.

Regardless "cosmetic" dentistry can be done by anyone and I would argue that its about the marketing that goes into it that matters the most. So why doesn't everyone just do "cosmetic" dentistry? My argument- it's damn hard to find a niche/area/population willing to spend 10-20,000 for smile makeovers...plus its hard work making sure its done correctly and in line with the patient's expectations. Three try-ins for 6-11 crowns...can be brutal on the lab bill and the mental anxiety.

 

[TanMan]

One thing to consider is that for the very fact that you are not making money during residency, you get to enjoy your vacation more. Compared that to when you are a GP, even taking a week off can lead to a significant loss of income. Residency also provides you with immediate help/bail out mechanism by faculty or senior residents. Not so sure if you can have the problem as readily taken care of in the real world as a GP. Keep in mind your reputation is on the line in the community once you are out.

That is why I do not like prosthodontics/FMR's. It is difficult and time consuming to isolate problems and costly to fix. With single teeth, if it fails, worst case... you lost a tooth.

Although it might be nice to have someone bail you out during residency, you can always get a specialist to bail you out (for a cost). What happens if you need to be bailed out as a newly minted specialist by a more experienced specialist? I think that looks even worse.

Information asymmetry is prevalent in service industries and although the rise of review sites have attempted to combat this, reputation management is not that difficult. Mass advertising, ORM, review services, a good personality, etc... can easily combat a poor reputation.

If you take a week off as a GP, you lose a week of GP income. If you take 3 years off as a GP to specialize, you lose 3 years of GP income.

 

[321931]

That is why I do not like prosthodontics/FMR's. It is difficult and time consuming to isolate problems and costly to fix. With single teeth, if it fails, worst case... you lost a tooth.

Although it might be nice to have someone bail you out during residency, you can always get a specialist to bail you out (for a cost). What happens if you need to be bailed out as a newly minted specialist by a more experienced specialist? I think that looks even worse.

Information asymmetry is prevalent in service industries and although the rise of review sites have attempted to combat this, reputation management is not that difficult. Mass advertising, ORM, review services, a good personality, etc... can easily combat a poor reputation.

If you take a week off as a GP, you lose a week of GP income. If you take 3 years off as a GP to specialize, you lose 3 years of GP income.

Compound 3 years of 7-8% interest on loans. Don't forget that.

 

[sb.tnh]

Although it might be nice to have someone bail you out during residency, you can always get a specialist to bail you out (for a cost). What happens if you need to be bailed out as a newly minted specialist by a more experienced specialist? I think that looks even worse.

Hi TanMan, thank you very much for your replies in this thread, they are very helpful. May I ask you how do you build a good relationship with a specialist so that they will bail you out most of the time? Referring a lot of cases to them?

 

[TanMan]

Hi TanMan, thank you very much for your replies in this thread, they are very helpful. May I ask you how do you build a good relationship with a specialist so that they will bail you out most of the time? Referring a lot of cases to them?

That's one part of the equation. Send a fair amount of cases of varying difficulty. Don't just send hard cases, mix them up with easy cases too. I have an all or nothing principle - if I send to an endo, I'll have them do all the endos, easy or hard, same with OS, I want them to take care of all areas/teeth in one shot, etc... That way, there's a mix of easy and difficult. Only exception is if they are in severe pain, I'll do that particular area and send the rest to the specialist with a note of why I did it. That way, they don't think I'm cherrypicking the case.

Second, I help them out as well. If the OS fractures a restoration or tooth adjacent to ext site, I'll fix it. If they admit fault to the patient, I don't charge the OS nor the patient even if they offer to pay for it (If the patient asks, I say the OS has it covered - even if I don't charge the OS). Sometimes, OS or perio might need a cast pour up, same deal, we'll pour it up if their restorative dentist is out of town. One more example is if they need me to do a post-op on a patient and they are unable to see them. Their patients are welcome in our office for a postop visit (builds my practice by gaining another patient, helps the specialist out, and builds goodwill). All these gestures build goodwill. I never throw the specialist under the bus and I expect them to do the same. I had an OS do that one time. It's been about 4 years since I referred anything to him and I still refuse to do any business with them.

Lastly, I don't dictate what my specialists do. I always say, do what you think is best for the patient. In my mind: I'll work around the circumstances.

 

[P7898]

Cosmetic focused dentists are a whole nother ballpark of dentistry. You see cosmetic dentists....market themselves as cosmetic dentists. While prosthodontists market themselves as "full mouth rehabilitation and or cosmetic dentists." The top three cosmetic dentists in my area are all...general practitioners. But they market themselves as THE cosmetic dentist.

Go type in Beverly Hills Cosmetic Dentist. The top three results are all General Dentists that have taken CE to do cosmetic work.

You don't have to search frantically. There are really only 2-3 courses for extensive cosmetic CE. Dawson, Spears, LVI, and a few others. It's not rocket science. The results on these CE courses are good but they are pricey.

The benefit of what Tanman is saying is that the lost opportunity cost of training, while loans are accumulating interest means that in the long run you are losing out compared to a GP owning his own practice and accumulating CE as they go.

Regardless "cosmetic" dentistry can be done by anyone and I would argue that its about the marketing that goes into it that matters the most. So why doesn't everyone just do "cosmetic" dentistry? My argument- it's damn hard to find a niche/area/population willing to spend 10-20,000 for smile makeovers...plus its hard work making sure its done correctly and in line with the patient's expectations. Three try-ins for 6-11 crowns...can be brutal on the lab bill and the mental anxiety.

You make some great points. I have seen a newly graduated prosthodontist turn out veneer and denture work at the same quality compared to a strictly cosmetic dentist that has been doing it for 15 years. I guess it boils down to what the person really wants and how they want to practice. Because the CE courses I am sure would take a long time to complete while practicing because there is a pre-requisite for the next level and so on. Not to mention the price of some of them (could be $8k a class for 4 classes). On the flip side, you still get to practice your skills you have acquired in an AEGD (3rd molar, endo, extractions), things you probably wouldn't advance in if you did a prosth residency.

 

[P7898]

That's one part of the equation. Send a fair amount of cases of varying difficulty. Don't just send hard cases, mix them up with easy cases too. I have an all or nothing principle - if I send to an endo, I'll have them do all the endos, easy or hard, same with OS, I want them to take care of all areas/teeth in one shot, etc... That way, there's a mix of easy and difficult. Only exception is if they are in severe pain, I'll do that particular area and send the rest to the specialist with a note of why I did it. That way, they don't think I'm cherrypicking the case.

Second, I help them out as well. If the OS fractures a restoration or tooth adjacent to ext site, I'll fix it. If they admit fault to the patient, I don't charge the OS nor the patient even if they offer to pay for it (If the patient asks, I say the OS has it covered - even if I don't charge the OS). Sometimes, OS or perio might need a cast pour up, same deal, we'll pour it up if their restorative dentist is out of town. One more example is if they need me to do a post-op on a patient and they are unable to see them. Their patients are welcome in our office for a postop visit (builds my practice by gaining another patient, helps the specialist out, and builds goodwill). All these gestures build goodwill. I never throw the specialist under the bus and I expect them to do the same. I had an OS do that one time. It's been about 4 years since I referred anything to him and I still refuse to do any business with them.

Lastly, I don't dictate what my specialists do. I always say, do what you think is best for the patient. In my mind: I'll work around the circumstances.

Thanks TanMan for your contributions to us students. Kind of a left field question and off topic but how often do you refer to an orthodontist? Are there a lot in your area?

 

[TanMan]

Thanks TanMan for your contributions to us students. Kind of a left field question and off topic but how often do you refer to an orthodontist? Are there a lot in your area?

I refer to ortho a lot. If they give me a lot of referrals, I reciprocate with a lot of referrals as well. There's quite a bit of orthodontists, but there's only 2 that I work with. I give more to one than the other due to the volumes I receive from one. I get all the perio/restorative/exts/endos, they get/keep the ortho. You would be surprised how many NP I get per week from the orthodontist... and mostly quality FFS patients nonetheless.

 

[2TH MVR]

I refer to ortho a lot. If they give me a lot of referrals, I reciprocate with a lot of referrals as well. There's quite a bit of orthodontists, but there's only 2 that I work with. I give more to one than the other due to the volumes I receive from one. I get all the perio/restorative/exts/endos, they get/keep the ortho. You would be surprised how many NP I get per week from the orthodontist... and mostly quality FFS patients nonetheless.

It's a political tightrope for the ortho on referring patients to GPs. Of course you always want to refer your quality patients to the best referring GPs who are feeding your practice. One of my past offices was next to a practice with 2 GPs. These guys made up more than 50% of all my dental referrals. Other GPs knowing that your right next door to GPs will be less willing to use you. When I used to go to lunch with new dentists. It was always the same line from the GP. They wanted referrals from my office BEFORE they would refer. Very, very difficult to please everyone.

My other office was located in a medical-dental office condo plaza. 5 GPs within a block of me. Imagine trying to please everyone. I finally just made friends with ONE office there and sent him all my restorative patients.

Fun times.

 

[P7898]

I refer to ortho a lot. If they give me a lot of referrals, I reciprocate with a lot of referrals as well. There's quite a bit of orthodontists, but there's only 2 that I work with. I give more to one than the other due to the volumes I receive from one. I get all the perio/restorative/exts/endos, they get/keep the ortho. You would be surprised how many NP I get per week from the orthodontist... and mostly quality FFS patients nonetheless.

Interesting concept. I didn't really know that prior. Do you find yourself referring more ortho then anything else? Since we are on the prosth talk, are you referring ortho more than complicated reconstructions?

 

[TanMan]

Interesting concept. I didn't really know that prior. Do you find yourself referring more ortho then anything else? Since we are on the prosth talk, are you referring ortho more than complicated reconstructions?

I refer a lot more ortho since there's a higher demand for ortho. People ask for it. I don't refer as much FMR's since the demand is lower. I currently refer to a perio-GP duo to handle those. They can go from immediate dentures all the way to all on X full arch fixed bridge. A lot of people who need FMR's usually don't have the financial means to do so in my area. I'd rather not deal with any dentures, partials or full arch restorations.

 

[P7898]

I refer a lot more ortho since there's a higher demand for ortho. People ask for it. I don't refer as much FMR's since the demand is lower. I currently refer to a perio-GP duo to handle those. They can go from immediate dentures all the way to all on X full arch fixed bridge. A lot of people who need FMR's usually don't have the financial means to do so in my area. I'd rather not deal with any dentures, partials or full arch restorations.

Makes sense. Seems like perio is in a good bit of demand.

 

[TanMan]

You do Invisalign right? Do you keep all those Invisalign patients for yourself? If you want to keep a patient for yourself, is it hard to convince that to them? Do patients prefer to be referred to specialists?

Patients want to stay with you. Invisalign is not a panacea for all things orthodontic. I use it mostly for relapse cases. It's a fine line to tread, but if it's not straightforward, I'll say that the specialist can provide better/more options.

 

[NMC2010]

I have a slightly different perspective. For someone in the military, would it be worthwhile for them to do a prosth program with limited/no debt, no program cost, and only a 3 year longer commitment? Then on the outside, have the option to practice as a general dentist and prosthodontist both since it might be difficult to do only prosth. Would this be worth it? Would it be frowned upon?

The other option would be to choose a different specialty, or just get out once commitment is up. But seems like prosth could enhance your scope of practice as a GP, still get good pay, and not have interest on debts to pay off. Or stay in the military for a career, then you basically have to specialize or you aren't really promotable.

 

[321931]

I have a slightly different perspective. For someone in the military, would it be worthwhile for them to do a prosth program with limited/no debt, no program cost, and only a 3 year longer commitment? Then on the outside, have the option to practice as a general dentist and prosthodontist both since it might be difficult to do only prosth. Would this be worth it? Would it be frowned upon?

The other option would be to choose a different specialty, or just get out once commitment is up. But seems like prosth could enhance your scope of practice as a GP, still get good pay, and not have interest on debts to pay off. Or stay in the military for a career, then you basically have to specialize or you aren't really promotable.

You could always be an expanded GP that does a lot of restorative. I sat down recently at lunch with my prosthodontist. He has a dual degree in perio and prosth. I asked him how many cases of full arch he does... his answer... 1 every few months. Implant overdentures? Maybe 1 every few months...

So I was like huh so what are you making your income on? He’s like I just practice as an extended GP practice where I just do everything and if the full mouth recon comes my way- I take care of it... he also makes a good buck from placing his own implants and restoring them.

but the typical full mouth textbook recon case just doesn’t really flow your way. The average American can’t even scrounge up 400 for an emergency and depending on sources has like 16k in savings. Those big projects cost 20...30...40k for dental work.

So yes expanded GP practice is a good way to go. My other prosthodontist who is just solely prosthodontist degree has his own hygiene program and just does fill and drill all day with the ability to tackle harder cases. Nothing wrong with that.

 

[2TH MVR]

My wife and I see a local prosthodontist for ALL of our dental care. He does everything and does it well.

 

[Big Time Hoosier]

I have a slightly different perspective. For someone in the military, would it be worthwhile for them to do a prosth program with limited/no debt, no program cost, and only a 3 year longer commitment? Then on the outside, have the option to practice as a general dentist and prosthodontist both since it might be difficult to do only prosth. Would this be worth it? Would it be frowned upon?

The other option would be to choose a different specialty, or just get out once commitment is up. But seems like prosth could enhance your scope of practice as a GP, still get good pay, and not have interest on debts to pay off. Or stay in the military for a career, then you basically have to specialize or you aren't really promotable.

Just get out and do it on your own with the GI Bill.

Big Hoss

 

[FutureDent020]

I have a slightly different perspective. For someone in the military, would it be worthwhile for them to do a prosth program with limited/no debt, no program cost, and only a 3 year longer commitment? Then on the outside, have the option to practice as a general dentist and prosthodontist both since it might be difficult to do only prosth. Would this be worth it? Would it be frowned upon?

The other option would be to choose a different specialty, or just get out once commitment is up. But seems like prosth could enhance your scope of practice as a GP, still get good pay, and not have interest on debts to pay off. Or stay in the military for a career, then you basically have to specialize or you aren't really promotable.

I have actually discussed this exact scenario with colleagues. Like Big Hoss said, I would just get out and use the GI. But that’s me. If you are set on retaining the salary, staying in 4-6 more years (depending on your commitment) and want to remain a GP after you separate it sounds like a sustainable plan. My only concern is the type of prosthodontic training you will receive at Bethesda. I can’t judge it too much because I have never done it, but it will not be as extensive or progressive as a civilian program. Military programs put their focus a little more on didactic / classic literature and then you sort of continue your clinical training during your serve back.

This path is definitely not frowned upon and is only worth it if you want to stay in a while longer. You can also practice as a high functioning GP without a prosth residency. The residency will just give you more confidence initially and a better foundation to grow on.

Being a prosthodontist in the military WILL help your transition a lot more when you move into private practice. From a clinical perspective, a military prosthodontist is basically a civilian GP who has good experience with restoring implants and expanded fixed. They are well educated and do a lot of teaching / admin in the military.

And btw, years of military GP work will set you back A LOT. Which is why, IMO, a lot of us decide to get out and specialize.

 

[Big Time Hoosier]

From a clinical perspective, a military prosthodontist is basically a civilian GP who has good experience with restoring implants and expanded fixed. They are well educated and do a lot of teaching / admin in the military.

And btw, years of military GP work will set you back A LOT. Which is why, IMO, a lot of us decide to get out and specialize.

This!

Big Hoss

 

[NMC2010]

It would be 3 more years for prosth program at Fort Gordon in the Army, or 2 more years for comp dentist residency. Also single and don't have a family to take care of. I may also want to teach in the future, but really not sure what I want to do because only experience is the Army. Being in private practice sounds stressful, tbh.

I can't speak for what it is like in the Army outside of residency, but it seems like at least the comprehensive dentists and specialists here get to do quite a bit of whatever they want. On of the comp dentists focuses mainly on implant restorations, the prosth people do tons of esthetic cases and FMR, etc. I'm also at a huge post, so it might be different at smaller places.


Frankly, I don't even know what a GP outside the Army does on a daily basis. Part of it is just a desire to be prepared once I'm done. Did most of you guys feel prepared once you finished dental school? Were you able to easily find a mentor to help you learn? Or is it pretty standard to shell out thousands on CE courses? Do you feel stressed as a GP outside the Army, or is it pretty laid back?

Why do you say lots of military GP work will set someone back?

 

[Big Time Hoosier]

Why do you say lots of military GP work will set someone back?

Because your skills will almost certainly atrophy from getting stuck doing nothing but fillings and exams. Like FutureDent020 said, military prosthodontist = well rounded civilian GP. It’s honestly a waste of their training.

I know that after 4 years of military dentistry, I am not prepared for GP private practice. My duty station is especially toxic in this regard. This is a big reason I advocate for HPSPers to GTFO ASAP. Fortunately, I’m headed to a specialty residency this summer when I get out, and this is the route the vast majority of my friends have taken and plan to take.

Big Hoss
ΦTN Chapter President

 

[Lil Norkii the Supreme]

Military dentistry is compromised of majority decent human beings working under minority toxic dinguses
If you hate dentistry and don’t necessarily have the discipline to save money for retirement military is perfect
Otherwise just gtfo asap
There are dinguses everywhere but military is where you are stuck with them for years without the option to quit

 

[NMC2010]

Military dentistry is compromised of majority decent human beings working under minority toxic dinguses
If you hate dentistry and don’t necessarily have the discipline to save money for retirement military is perfect
Otherwise just gtfo asap
There are dinguses everywhere but military is where you are stuck with them for years without the option to quit

That sucks man. Everyone here has been great to the soldiers, me, and the docs at the other clinics. As you said, bad people could apply to other situations like being an associate, in corporate, etc (where you also often have contracts, just shorter). Most beginning dentists don't just open their own practices straight out of school.

Sorry you guys have all had such harrowing experiences.

Relative to being a GP in the military setting you back, that definitely would be a serious reason to get out.