How is future of oral surgery?

[mmpatel0]

With perio guys starting to do thirds and learning sedation

and GPs and Pros and anyone doing implants

How is outlook of private practice bread-n-butter Oral Surgery?

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[briansle]

I spoke to a practice broker couple months ago.
Sees alot of OS guys doing the whole "OS on wheels". Bouncing from one GP clinic to another.
Told me, it's not like the old days anymore.
But then again what is?
Definitely do it for the love, not the money.

 

[mmpatel0]

I spoke to a practice broker couple months ago.
Sees alot of OS guys doing the whole "OS on wheels". Bouncing from one GP clinic to another.
Told me, it's not like the old days anymore.
But then again what is?
Definitely do it for the love, not the money.

This makes me think what's the whole point of doing OS unless you really love it.

You work like **** for 4~6 years
And after you're done with residency
You're either hired by GP
or open up a private practice and suck local GPs' ass for referrals especially in these days when GPs are dying to keep everything in-house.


Yet again, I still hear some chief residents getting a job at midwest getting paid 500k+ first year out of residency... so who knows.

 

[periopocket]

Is the outlook different between those with an MD vs. W/o?

 

[tjung789]

Is the outlook different between those with an MD vs. W/o?

not really. an MD will make it easier for an OMFS to go into academics and get academic positions but that is about it. Now, if you decide to be an OMFS and get an MD and do a fellowship in cosmetics then maybe you could do a little plastic surgery procedures ($$$). But keep in mind even plastic surgery is very competitive in terms of business environment.

I feel getting an MD vs non-md is like deciding whether do omfs or not: only do it if you REALLY want to.

 

[Localnative]

I spoke to a practice broker couple months ago.
Sees alot of OS guys doing the whole "OS on wheels". Bouncing from one GP clinic to another.
Told me, it's not like the old days anymore.
But then again what is?
Definitely do it for the love, not the money.

I'm working in a very saturated part of the southeastern US currently and it's a very tough environment. Throughout the week I'm doing a bit corporate, some private offices, some long hauls (1.5 hour travel time to one office) and doing 1 day of my own thing. And that's what it takes to survive right now. Have to pay off medical and dental loans, have to put food on the table for the family. That's the reality of OS in my locale... you have to hit the pavement and make alot of friends. I like what I do, but trust me being a traveling man takes a bit of the wind out of you.

I know this is old advice, but always be open to exploring less sexy places to live. Sure, Smalltown, WV may not be ideal, but if the community need is there and you have great foresight and determination, you can make it work. Don't know about this $500,000 salary right outta practice, but I'm sure the compensation is very healthy if you're one of a handful of specialists in a 250 mile radius.

 

[Shunwei]

Location is definitely the key. It doesn't matter who you are, how good you think you are, the one biggest factor is still location and saturation. I have heard of OS's making great money in the midwest (more than 500k), and those that don't do so well (in CA). Demand and supply will always be the underlying driver of all economics, dentistry included.

Having said that, I think OS is a good field to get into. You get specialized training in the most difficult field (in my opinion), and the number of graduates is tightly controlled. Even if you just do 3rds all day long, you can still make great money coupled with IV sedation. It does look, however, like the future of the field is for OS's to do more of a traveling gig.

 

[periopocket]

I love malignant pathology!

 

[CaliDDS1986]

It's all location. Guy in my town started an os practice 30 years ago, all FFS one chair. Gradually grew it to where its a clinic now with multiple surgeons. He is nearing retirement, but made a ton. Other OS's over the years came into the area and the new guys take Medicaid and the lower tier insurances. It's all location, end of story. If you find a place where your the only show in town, you'll be fine. If you go where there's other shows playing, you'll make less.

 

[IHO]

OP, the future for OS is so bright I've got to wear shades. A lot of it will depend on where you want to practice and what kind of practice you want to have. Even if your practice is in the bottom quintile of FT OSs (with regards to income) you will still be doing better than 90-95% of americans. Odds are, ANY dentist will be doing better than the vast majority of americans. so, specialize if you have an interest, otherwise be a general dentist. When it comes to this profession, the axiom "do what you love and the money will come" holds true.

On a side note that came up in this thread, what are thoughts on "OS on wheels". In some regards, it seems like a dream gig...no employer/administrative/overhead headaches, tremendous flexibility in setting up your schedule and taking vacations, no hospitals. The downsides? How do you handle call for post op patients? Any OS whos been in private practice for a few months learns 99% of post op calls are complete non-emergent nonsense ( I had my wisdom teeth out 2 days ago and am swollen; I had my teeth out a month ago can I start brushing ?; I had my teeth out 7 days ago can I eat blueberries?; my stich came out; I had my teeth out 3 days ago, can I start smoking? ectectect) but what do you do for that 1 in 100 calls that does require some urgent eval/tx...do you rely on the general dentist for that? What about the neck abscess that need to be admitted for IV abx?

I have considered closing down my brick and mortar practice in 5-10 years (when hopefuly I will have a lot more financial freedom) and going to a 1/2 or 2/3 time travelling OS gig, but I wonder...is it feasible? If anyone has had experience with this, as a surgeon or as a dentist hiring the surgeon, I would be interested in your thoughts.

Cheers

 

[Diezel69x]

With perio guys starting to do thirds and learning sedation

and GPs and Pros and anyone doing implants

How is outlook of private practice bread-n-butter Oral Surgery?

I dont think perio is after thirds so much. Implants YES! I think oral surgeons need to be more worried about insurance cuts than periodontists, as all fields in dentistry and medicine...

Also not in the near future (thank god), but many are trying to target IV sedation, so that may be a problem at some point to...

 

[Localnative]

I have considered closing down my brick and mortar practice in 5-10 years (when hopefuly I will have a lot more financial freedom) and going to a 1/2 or 2/3 time travelling OS gig, but I wonder...is it feasible? If anyone has had experience with this, as a surgeon or as a dentist hiring the surgeon, I would be interested in your thoughts

Totally feasible, but it can be exhausting between managing your own practice part time, travelling to the myriad offices and taking some hospital call. I work in a region where a ton of GPs have OS come to the office so they can take care of everything internally. I've found you have less control of scheduling and there is a larger no-show rate (my personal experience). Also you have to be permitted anywhere you do IV. Most GP offices are not set up for this, don't have the personnel, etc. You many have to bring your own assistants with you as the GP offices don't have properly trained staff to do OS (airway control, surgical field management, instrument set-up, the lingo of OS). If you work in a GPs office negotiate for a daily minimum draw vs a straight % of PRODUCTION (not impossible). For example, ask for a daily rate of $1500 for coming to the office vs 50% of whatever you produce. You HAVE to make each gig worth your while. You HAVE to carefully negotiate surgical fees. I cover my own liability (premium over 20,000/yr, I'll leave it at that) and I expect to be compensated fairly (litigation in my region is rampant). Ideally I would LOVE LOVE LOVE to go back, do a fellowship, work an academic job, but this is what I'm doing for the time being to be (financially) pragmatic.

You will almost inevitably burn that candle from both ends, but if you plan the traveling gig carefully it can be very much worth your while.

 

[Xigris14]

I am not a fan of the traveling Oral Surgeon but the reason for this is two fold. 1) Dentist are getting greedy and don't want to refer out when they can keep it in house. 2) Too many oral surgeons in one area with not enough business, therefore they market themselves as these traveling oral surgeons.

Dentist think its so easy to take out thirds that you should do it in the office, including complete bony impacted thirds and on 15 year olds with no history of restorative work. Excuse me Dr. Would you like to do these thirds under local if they are no big deal and can be done under local? Oh ok then just sedate in my office Mr oral surgeon. Oh excuse me Dr. It is very easy to get your office IV sedated approved, the emergency drugs, equipment, assistant, drug registration, malpractice, etc... Come on... Thats why we have approved offices with our own assistances to accommodate these types of cases. I will come to your office for regular ext and implant cases. Stop being greedy, but there are OMFS willing to do anything for the dollar and thus when some of these dentist see or hear their pales making more money buy advertising OMFS to come to their office then this is what you get. Perio and Endo are doing the same at GP offices. Sometimes we need to say no and keep our private practice motto not the traveling circus motto.

 

[OrthoK]

Assistants-->Hygienists--->Therapists-->GP-->All Specialties

 

[Localnative]

I am not a fan of the traveling Oral Surgeon but the reason for this is two fold. 1) Dentist are getting greedy and don't want to refer out when they can keep it in house. 2) Too many oral surgeons in one area with not enough business, therefore they market themselves as these traveling oral surgeons.

Dentist think its so easy to take out thirds that you should do it in the office, including complete bony impacted thirds and on 15 year olds with no history of restorative work. Excuse me Dr. Would you like to do these thirds under local if they are no big deal and can be done under local? Oh ok then just sedate in my office Mr oral surgeon. Oh excuse me Dr. It is very easy to get your office IV sedated approved, the emergency drugs, equipment, assistant, drug registration, malpractice, etc... Come on... Thats why we have approved offices with our own assistances to accommodate these types of cases. I will come to your office for regular ext and implant cases. Stop being greedy, but there are OMFS willing to do anything for the dollar and thus when some of these dentist see or hear their pales making more money buy advertising OMFS to come to their office then this is what you get. Perio and Endo are doing the same at GP offices. Sometimes we need to say no and keep our private practice motto not the traveling circus motto.

Hey Chief, if you have a family and mounds of debt, sometimes you have to do things to keep yourself afloat, so don't judge.

Where are you located? I'd like to see you come down to my neck of the woods with your holier than thou attitude and see how you manage.

Blah blah blah, everyone has a choice, blah blah blah, let's protect our private practice interests.

Ideally I would have none of this "traveling circus", but again when you have to make a living (um, worlds away from the concept of GREED smart ass), you have to man up to put food on the table. And that means doing things you normally wouldn't do if the economic picture were a wee bit brighter.

 

[periopocket]

Assistants-->Hygienists--->Therapists-->GP-->All Specialties

? Clarify please?

 

[tjung789]

I am not a fan of the traveling Oral Surgeon but the reason for this is two fold. 1) Dentist are getting greedy and don't want to refer out when they can keep it in house. 2) Too many oral surgeons in one area with not enough business, therefore they market themselves as these traveling oral surgeons.

Dentist think its so easy to take out thirds that you should do it in the office, including complete bony impacted thirds and on 15 year olds with no history of restorative work. Excuse me Dr. Would you like to do these thirds under local if they are no big deal and can be done under local? Oh ok then just sedate in my office Mr oral surgeon. Oh excuse me Dr. It is very easy to get your office IV sedated approved, the emergency drugs, equipment, assistant, drug registration, malpractice, etc... Come on... Thats why we have approved offices with our own assistances to accommodate these types of cases. I will come to your office for regular ext and implant cases. Stop being greedy, but there are OMFS willing to do anything for the dollar and thus when some of these dentist see or hear their pales making more money buy advertising OMFS to come to their office then this is what you get. Perio and Endo are doing the same at GP offices. Sometimes we need to say no and keep our private practice motto not the traveling circus motto.

I am interested in cutting into the bottom line of OMFS and was wondering whether you could give me any tips?

 

[Xigris14]

some advice. move..

i did and now i am not part of the circus show allowing these dentist to own us and have us by the balls. i did not go to 6 years of residency for that crap. but i understand when private practice in your area is not going well you got to do what yo got to do. thats why i moved.

 

[Silent Cool]

some advice. move..

i did and now i am not part of the circus show allowing these dentist to own us and have us by the balls. i did not go to 6 years of residency for that crap. but i understand when private practice in your area is not going well you got to do what yo got to do. thats why i moved.

Xigris: what sort of income can an oral surgeon expect these days?
New grad?
5 years out?

thanx

 

[Xigris14]

it all depends on where you practice. Academics forget it, your not getting paid much. The classified adds have numerous openings in Academics but when you start around 170k-200k and stay there forever until you climb the academic ladder to only then get another 10-20k more a year after 5 years, Who is going to take that??? Not me.

Now private practice. If you practice in places like Boston, NYC, Florida, CA, Chicago get ready for on average 180-220k a year gross. On average give or take. These places have oral surgeons now in the traveling circus going by dentist office to dentist office just to try and supplement their income from their practice. And why, because too many damn surgeons and not as many patients. In this day of age you have GP, AEGD, GPR, Perio, and other OMFS competing for implants and some thirds. Gone are the days of OMFS doing it all unless your in certain cities with older dentist that is not a popular place to be such as Wyoming for example. Sorry I have nothing against your state if you live there, just using that as an example compared to NYC. So if you do go to these non saturated and not so popular areas then you may get a starting salary around 275-300k on average. Plus less competition. After 5 years it all depends on your contract and buy in. You will be making more probably >400k but again all depends on your contract.

I just read a classified add in my local dental magazine where I practice stating, "OMFS with all equipment and implants looking to go to GP offices to place implants so your patients dont have to travel out of practice" WTF!! Bring on the clowns and popcorn cause this circus is here to stay. We just need to adapt. Hope this helps.

 

[ortho lurker]

I just read a classified add in my local dental magazine where I practice stating, "OMFS with all equipment and implants looking to go to GP offices to place implants so your patients dont have to travel out of practice" WTF!! Bring on the clowns and popcorn cause this circus is here to stay. We just need to adapt. Hope this helps.

Lol.

 

[Shunwei]

it all depends on where you practice. Academics forget it, your not getting paid much. The classified adds have numerous openings in Academics but when you start around 170k-200k and stay there forever until you climb the academic ladder to only then get another 10-20k more a year after 5 years, Who is going to take that??? Not me.

Now private practice. If you practice in places like Boston, NYC, Florida, CA, Chicago get ready for on average 180-220k a year gross. On average give or take. These places have oral surgeons now in the traveling circus going by dentist office to dentist office just to try and supplement their income from their practice. And why, because too many damn surgeons and not as many patients. In this day of age you have GP, AEGD, GPR, Perio, and other OMFS competing for implants and some thirds. Gone are the days of OMFS doing it all unless your in certain cities with older dentist that is not a popular place to be such as Wyoming for example. Sorry I have nothing against your state if you live there, just using that as an example compared to NYC. So if you do go to these non saturated and not so popular areas then you may get a starting salary around 275-300k on average. Plus less competition. After 5 years it all depends on your contract and buy in. You will be making more probably >400k but again all depends on your contract.

I just read a classified add in my local dental magazine where I practice stating, "OMFS with all equipment and implants looking to go to GP offices to place implants so your patients dont have to travel out of practice" WTF!! Bring on the clowns and popcorn cause this circus is here to stay. We just need to adapt. Hope this helps.

These figures sound about right from my observations of OMFS. Some people have exorbitant expectations about e earning power of OS nowadays. One classmate of mine whose girlfriend is in an OMFS program in NYC claims at her programs graduates can expect an offer of 800k in NYC on graduation. Even with my knowledge back then I thought it was too high.

I think the root of all of this problem is the increased saturation of dentists. More and more GPs are being forced to do and specialize in things that would have traditionally gone to specialists. I for one do almost everything on my own except for the extreme procedures w/high risk and low yield like FBI thirds and eno retreats. This encroachment has really hurt specialists as a whole, and as Xigris mentioned perio is also carving its own pie from OMFS.

 

[yappy]

These figures sound about right from my observations of OMFS. Some people have exorbitant expectations about e earning power of OS nowadays. One classmate of mine whose girlfriend is in an OMFS program in NYC claims at her programs graduates can expect an offer of 800k in NYC on graduation. Even with my knowledge back then I thought it was too high.

I think the root of all of this problem is the increased saturation of dentists. More and more GPs are being forced to do and specialize in things that would have traditionally gone to specialists. I for one do almost everything on my own except for the extreme procedures w/high risk and low yield like FBI thirds and eno retreats. This encroachment has really hurt specialists as a whole, and as Xigris mentioned perio is also carving its own pie from OMFS.

On the other end I feel that the supply of patients is limited because of the under-performing economy.

To use an analogy it seems like GP's are climbing up higher on the treatment ladder to pick fruit; because, there is less low hanging bread-and-butter cases. I think many people are putting off, or ignoring, their dental needs because they are unemployed or underemployed.

 

[Silent Cool]

it all depends on where you practice. Academics forget it, your not getting paid much. The classified adds have numerous openings in Academics but when you start around 170k-200k and stay there forever until you climb the academic ladder to only then get another 10-20k more a year after 5 years, Who is going to take that??? Not me.

Now private practice. If you practice in places like Boston, NYC, Florida, CA, Chicago get ready for on average 180-220k a year gross. On average give or take. These places have oral surgeons now in the traveling circus going by dentist office to dentist office just to try and supplement their income from their practice. And why, because too many damn surgeons and not as many patients. In this day of age you have GP, AEGD, GPR, Perio, and other OMFS competing for implants and some thirds. Gone are the days of OMFS doing it all unless your in certain cities with older dentist that is not a popular place to be such as Wyoming for example. Sorry I have nothing against your state if you live there, just using that as an example compared to NYC. So if you do go to these non saturated and not so popular areas then you may get a starting salary around 275-300k on average. Plus less competition. After 5 years it all depends on your contract and buy in. You will be making more probably >400k but again all depends on your contract.

I just read a classified add in my local dental magazine where I practice stating, "OMFS with all equipment and implants looking to go to GP offices to place implants so your patients dont have to travel out of practice" WTF!! Bring on the clowns and popcorn cause this circus is here to stay. We just need to adapt. Hope this helps.

Xigris,

Great information. Thanks a lot. I appreciate it!

 

[Silent Cool]

On the other end I feel that the supply of patients is limited because of the under-performing economy.

To use an analogy it seems like GP's are climbing up higher on the treatment ladder to pick fruit; because, there is less low hanging bread-and-butter cases. I think many people are putting off, or ignoring, their dental needs because they are unemployed or underemployed.

Yappy, I agree. Whenever the economy tanks, there are always multiple stories about how badly dentists fare. That, and of course because of the bad economy the older dentists aren't retiring, which contributes to the saturation issue. If the old fogies would start checking out en masse, and the economy got significantly better, I think it would be business as usual again.

 

[Shunwei]

On the other end I feel that the supply of patients is limited because of the under-performing economy.

To use an analogy it seems like GP's are climbing up higher on the treatment ladder to pick fruit; because, there is less low hanging bread-and-butter cases. I think many people are putting off, or ignoring, their dental needs because they are unemployed or underemployed.

To some extent you have a point, but as a healthcare field I feel that dentistry is somewhat more cushioned against economic conditions than, say, an MBA. I think the phenomenon of these traveling specialists is more common in an urban setting, where saturation if dentists is much more prevalent. In more rural areas, I still see plenty of GPs happily do bread and butter dentistry and refer out the specialist procedure freely. In a metro setting where there is a dental office at every street corner, if you don't do it, Dr. X or Y down the street quite likely will and you very likely have lost that patient to at office.

I also feel that there is a shift in paradigm and philosophy among GPs per se. With the prevalence of CE courses and an increasing awareness that many specialist procedures are, indeed, doable by a general dentist, it is small wonder that GPs are increasing reluctant to do the traditional referrals. Now, I don't advocate GPs getting in over their heads in exceedingly difficult procedures, but there are many procedures like most endos, simple perio (crown lengthening, pocket reduction), simple implants that well-trained, ethical GPs like myself can do. It is unfortunate that my specialist colleagues get so few referrals from me, but if I can do something well why refer out?

My feeling is that these traveling specialists will become the norm in the future. Slowly becoming extinct are the days of the individual, brick-and-mortar specialist practices. Unfortunately for the specialists, this trend tends to tilt the balance in favor for the generalists.

 

[Sublimazing]

On the other end I feel that the supply of patients is limited because of the under-performing economy.

To use an analogy it seems like GP's are climbing up higher on the treatment ladder to pick fruit; because, there is less low hanging bread-and-butter cases. I think many people are putting off, or ignoring, their dental needs because they are unemployed or underemployed.

So these are bread and butter trees in your example?

 

[Xigris14]

good point. Shunwei

If you were to think 10 years ago and think GP without or with additional training (GPR/AEGD/Internship or CE courses) would be tackling some thirds, implants, grafts soft and hard tissue you would say NO Way. But Way. Its happening. Im ok with it as long as the practitioner is competent and not putting money first before patient care. You know what I mean.

Sure I would love to do 100% of Implants, Grafts, Thirds, Path etc from a dental practice but I have to accept the current way of practice and that others that are out there capable of doing similar procedures as myself. Again I have to adapt of which I am doing.

 

[ann k]

Hi guys ! interesting discussion..
Iam a fresh graduate from canada and wondering bout aspect of oral surgery and also thinking bout GPR. wts the benefits of GPR?

 

[InMyCrossHairs]

You are slowly digging your own grave if you cave into to being a GP's little B!!tch. Have some respect and dignity. Go out, be patient and build your own practice. Did you really go through all that training to some day report to some greedy GP. These Gypsy Oral Surgeons have been infiltrating our market, and they have slowly complicated the way we practice. Many have no hospital privileges, are never available to handle legitimate post op complications, and are nothing more that sell outs.

Call me what you want, but at least I am still my own boss, and I am not responsible for cheapening our profession.

 

[Craniomaxface]

academic salaries are a little better than what you state but none of us go into it for the money

 

[tjung789]

You are slowly digging your own grave if you cave into to being a GP's little B!!tch. Have some respect and dignity. Go out, be patient and build your own practice. Did you really go through all that training to some day report to some greedy GP. These Gypsy Oral Surgeons have been infiltrating our market, and they have slowly complicated the way we practice. Many have no hospital privileges, are never available to handle legitimate post op complications, and are nothing more that sell outs.

Call me what you want, but at least I am still my own boss, and I am not responsible for cheapening our profession.

You think the GP won't refer to another oral surgeon who would be willing to subject themselves to a little lower "respect and dignity"? Your narrow minded thinking only works for Oral Surgeons who are NOT in saturated areas (there are VERY FEW UNsaturated areas left). If a GP doesn't refer good patients after you help them, then yes you can stop taking referrals from the GP.

But that is how you start your practice. No one is going to just refer good patients right off the bat to you when you open up. You have to prove to the GP that you can tackle tough cases, will be there when a complication arises for the GP's patient. This means that initially you will have to put up with some lower dignity and respect. If you are unwilling to do so, then another oral surgeon who is willing to do so will take your business. This is especially true in areas where there are other oral surgeons practicing (often the desirable areas)

I've seen a lot of specialists complain here about how they have to do 'dirty work' and 'kiss up to the GPs' . If you did not like this, then you should have NOT become a specialist.

 

[gryffindor]

I've seen a lot of specialists complain here about how they have to do 'dirty work' and 'kiss up to the GPs' . If you did not like this, then you should have NOT become a specialist.

I didn't sense from crosshair's post that he was complaining about doing the dirty work.

I think he has a point about OMS who sell out and only do the easy stuff because the hard stuff requires hospital privileges. The GP is too greedy to refer the easy stuff out and in a saturated market will find some sucker to come in and take the offer. I used to get asked to be a gypsy orthodontist often. The GP can't see past the $5K case fee and wants a slice of that. I said no because I think quality of care suffers in the so-called "multispecialty" environment. Sure you can send me all your dirty work, but there are limits to my miracles. If your 34 yo male with narrow maxilla, bilateral crossbite and severe crowding refuses extractions and a surgical RPE, well I'm out of options and he's going to go back to you and complain that "the specialist didn't do anything."

 

[Shunwei]

Another point worth bearing in mind is that this specialist nomad trend is also at least partly contributed by the expanding corporate environment. Often times its not the GPs who are greedy, it's the dental corporations that are. Corporate dentistry try as much as possible to keep everything "in-house" and in doing so are one of the main drivers in hiring these traveling specialists. And in doing so, this is forcing the private, non-corporate practitioners out there to also do the same in order to survive, in addition to competitive pressures due to saturation.

 

[D.D.S.]

Another point worth bearing in mind is that this specialist nomad trend is also at least partly contributed by the expanding corporate environment. Often times its not the GPs who are greedy, it's the dental corporations that are. Corporate dentistry try as much as possible to keep everything "in-house" and in doing so are one of the main drivers in hiring these traveling specialists. And in doing so, this is forcing the private, non-corporate practitioners out there to also do the same in order to survive, in addition to competitive pressures due to saturation.

Well then I guess if you cant beat them, you'll just have to join them!!

 

[Shunwei]

Well then I guess if you cant beat them, you'll just have to join them!!

That's certainly been the trend in pharmacy!