How many of you specialized because you don’t enjoy general dentistry?

[dwn-test]

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Title.

 

[Boat on the Chesapeake]

Sort of. I enjoyed general dentistry but liked Endo most, hated the unpredictability of dentures and peds.

You don’t have to do a residency to “specialize” your practice more, unless you really want to be the best in one specific area. Do more or less surgery if you like, more or less peds, cosmetics, endo, etc. Take courses and get good and predictable at what you like and refer out or have another doc in your practice that does what you don’t like.

 

[nade0016]

Title.

me

 

[TheLastDance]

General dentistry PPO for adults in a bread and butter model is cooked with insurance 100%. The small percent of GP dentists who do extremely well in this space are either legacy inheritance in a practice, children of wealthy parents to fund or support a startup/buyout, live in a remote area with a spouse that supports them, or straight up pay for 100-200K in CE to become a super GP doing the highest risk liability procedures. There is no middle ground associating or owning PPO if you're below the curve in any of these ways. There's a reason why specialties now are even harder to get.

 

[Pablo Sanchez]

General dentistry PPO for adults in a bread and butter model is cooked with insurance 100%. The small percent of GP dentists who do extremely well in this space are either legacy inheritance in a practice, children of wealthy parents to fund or support a startup/buyout, live in a remote area with a spouse that supports them, or straight up pay for 100-200K in CE to become a super GP doing the highest risk liability procedures. There is no middle ground associating or owning PPO if you're below the curve in any of these ways. There's a reason why specialties now are even harder to get.

That is a stretch.

 

[TheLastDance]

That is a stretch.

Is it? General dentistry as an associate (or even a bread and butter owner) is miserable if you're not rural. Have you genuinely worked in general dentistry PPO for multiple years in any urban environment? Corporate? Small office? In network? 90%+ of US dentist offices take PPO Delta/UHC/Cigna which 100% work directly against you to deny treatment/services you perform. This ruins your ability to run or sustain an office. Most offices geographically cannot afford to be OON or FFS. Most patients want an office that takes their insurance YoY. Insurance rates for general dentists are straight up robbery as an owner and this is before any expenses for staff, materials, HR/billing, building, or facilities. They deny your services on first billing but guess what, your bills still have to be paid.

The reality in 2025 is if you're not (1) owning OON FFS, (2) specializing, (3) being a Medicaid volume mill, or (4) partnering into a big group (with as little debt as possible) you're cooked working with insurance as a general dentist or an associate. Insurances have posted UCRs largely favoring specialists for better rates, better fee schedules, and better practice negotiations for the same larger/niche procedures that a general dentist could historically do for their clientele or was capable of doing for at a smaller fee in the past. Why do these harder specialty procedures when you're getting paid less? This forces people to go to specialists on referral because it's simply not worth the headache at any IN insurance level.

Even worse, the amount of value you have to provide at the general dentist practice level is unreasonably high. You're resigned as a general dentist to be unbelievably good at cosmetic makeovers + AOX + extremely heavy branding (take out an extra 100-200K in CE) to compete on a large-scale level which comes at a way bigger liability for your perceived skill level than ever before. There's a reason why OON and FFS is so out of reach for 9/10 dentists in this country.

Now if you're talking rural general dentistry? Totally different story, but comes with massive personal sacrifices if you're on your own (eg. loneliness).

 

[FloridaDental_2024]

Is it? General dentistry as an associate (or even a bread and butter owner) is miserable if you're not rural. Have you genuinely worked in general dentistry PPO for multiple years in any urban environment? Corporate? Small office? In network? 90%+ of US dentist offices take PPO Delta/UHC/Cigna which 100% work directly against you to deny treatment/services you perform. This ruins your ability to run or sustain an office. Most offices geographically cannot afford to be OON or FFS. Most patients want an office that takes their insurance YoY. Insurance rates for general dentists are straight up robbery as an owner and this is before any expenses for staff, materials, HR/billing, building, or facilities. They deny your services on first billing but guess what, your bills still have to be paid.

The reality in 2025 is if you're not (1) owning OON FFS, (2) specializing, (3) being a Medicaid volume mill, or (4) partnering into a big group (with as little debt as possible) you're cooked working with insurance as a general dentist or an associate. Insurances have posted UCRs largely favoring specialists for better rates, better fee schedules, and better practice negotiations for the same larger/niche procedures that a general dentist could historically do for their clientele or was capable of doing for at a smaller fee in the past. Why do these harder specialty procedures when you're getting paid less? This forces people to go to specialists on referral because it's simply not worth the headache at any IN insurance level.

Even worse, the amount of value you have to provide at the general dentist practice level is unreasonably high. You're resigned as a general dentist to be unbelievably good at cosmetic makeovers + AOX + extremely heavy branding (take out an extra 100-200K in CE) to compete on a large-scale level which comes at a way bigger liability for your perceived skill level than ever before. There's a reason why OON and FFS is so out of reach for 9/10 dentists in this country.

Now if you're talking rural general dentistry? Totally different story, but comes with massive personal sacrifices if you're on your own (eg. loneliness).

any rural areas do you recommend for a newly graduate, the sooner to pay off a $300K debt, the better.

 

[Pablo Sanchez]

Is it? General dentistry as an associate (or even a bread and butter owner) is miserable if you're not rural. Have you genuinely worked in general dentistry PPO for multiple years in any urban environment? Corporate? Small office? In network? 90%+ of US dentist offices take PPO Delta/UHC/Cigna which 100% work directly against you to deny treatment/services you perform. This ruins your ability to run or sustain an office. Most offices geographically cannot afford to be OON or FFS. Most patients want an office that takes their insurance YoY. Insurance rates for general dentists are straight up robbery as an owner and this is before any expenses for staff, materials, HR/billing, building, or facilities. They deny your services on first billing but guess what, your bills still have to be paid.

The reality in 2025 is if you're not (1) owning OON FFS, (2) specializing, (3) being a Medicaid volume mill, or (4) partnering into a big group (with as little debt as possible) you're cooked working with insurance as a general dentist or an associate. Insurances have posted UCRs largely favoring specialists for better rates, better fee schedules, and better practice negotiations for the same larger/niche procedures that a general dentist could historically do for their clientele or was capable of doing for at a smaller fee in the past. Why do these harder specialty procedures when you're getting paid less? This forces people to go to specialists on referral because it's simply not worth the headache at any IN insurance level.

Even worse, the amount of value you have to provide at the general dentist practice level is unreasonably high. You're resigned as a general dentist to be unbelievably good at cosmetic makeovers + AOX + extremely heavy branding (take out an extra 100-200K in CE) to compete on a large-scale level which comes at a way bigger liability for your perceived skill level than ever before. There's a reason why OON and FFS is so out of reach for 9/10 dentists in this country.

Now if you're talking rural general dentistry? Totally different story, but comes with massive personal sacrifices if you're on your own (eg. loneliness).

You can speak to your experiences as a general dentist. I am an associate general dentist working 25 minutes outside of one of the largest cities in the country who has had the opposite experience. It’s a largely PPO office. No medicaid. In network with Delta/UHC/Cigna. Been working here for three years and make over $400k per year as an associate.

I do mostly bread and butter dentistry. I do also do extractions, bone grafts, implants, molar endo, clear aligners, etc. I do occasionally restore AOX cases, but I work with the specialist for implant placement for the AOX cases. Most of what I do is restorative on a day to day basis.

 

[Life of Pablo]

I preface this by saying no offense:

I couldn’t do general dentistry. For the most part, patients do not really appreciate what you do. You just did a perfect MODBL filling on 2 adjacent teeth on a patient? Often times they don’t care, and they don’t even know what that is. You just had perfect margins on a sub gingival crown prep? Again, patients don’t even know what that means. On average, the pay is crap compared to the amount of debt and time you put into it.

Nope, general dentistry is not for me.

 

[Torshammer]

I went into endo because I loved endo but also because I despised my life as a general dentist tbh. Pay was mediocre + my level of knowledge and expertise in my craft was low. Job satisfaction is very high now that I'm in endo. I assume this is the case with many specialists.

 

[Pablo Sanchez]

I preface this by saying no offense:

I could never do general dentistry. For the most part, patients do not appreciate what you do. You just did a perfect MODBL filling on 2 adjacent teeth on a patient? They don’t care. They don’t even know what that is. You just had perfect margins on a sub gingival crown prep? Who cares. You’re a jack of all trades and master of none. On average, the pay is crap compared to the amount of debt and time you put into it.

Nope, general dentistry is not for me.

And the 18 year old who you took out unerupted wisdom teeth on while they were asleep really shows you life altering appreciation?

The pediatric patient who just wants to get home to watch Bluey shows their dentist appreciation?

The non-compliant kid who had braces on for two years and doesn’t wear his retainers a day after getting their braces off really appreciates their orthodontist?

The endodontist who does a retreat on an asymptomatic tooth because their dentist saw a PARL on the x ray really feels appreciated?

The reality is that each field of dentistry is going to have the opportunity to care for patients and change their lives. Some patients will truly appreciate you, others won’t. You can’t point to a single procedure/example and paint that as being representative of the whole specialty.

 

[dwn-test]

me

what specialty did you enter into?

 

[JacquesVallee]

any rural areas do you recommend for a newly graduate, the sooner to pay off a $300K debt, the better.

If you're truly willing to move anywhere, just take a look around at rural jobs across the country. Some people think "rural" is living 30 minutes outside of a major city. Really, you need to live 2-3 hours away typically. I have heard decent things about an hour outside of major cities in Texas, though.

I was able to get a guarantee of 15k a month on four days a week rural. I had another job offer for 170k a year on four days a week guaranteed. These were in places where it was very hard for them to find associates, far away from the city. Living where I lived was very very tough being a single guy. There was nothing to do and almost no young adult community. My old job that I left still hasn't even come close to finding a replacement for me. It's a sacrifice but let's you practice dentistry in a traditional way that is completely lost in cities. I have classmates who have to dance on social media. I'm so lucky to have been away from that chaos and not have to subject myself to that.

 

[Pablo Sanchez]

I have classmates who have to dance on social media. I'm so lucky to have been away from that chaos and not have to subject myself to that.

😂😂😂 I think if I had to dance on social media it would actually turn patients away. Can’t be going to a dentist who is stiff as a brick.

 

[FloridaDental_2024]

If you're truly willing to move anywhere, just take a look around at rural jobs across the country. Some people think "rural" is living 30 minutes outside of a major city. Really, you need to live 2-3 hours away typically. I have heard decent things about an hour outside of major cities in Texas, though.

I was able to get a guarantee of 15k a month on four days a week rural. I had another job offer for 170k a year on four days a week guaranteed. These were in places where it was very hard for them to find associates, far away from the city. Living where I lived was very very tough being a single guy. There was nothing to do and almost no young adult community. My old job that I left still hasn't even come close to finding a replacement for me. It's a sacrifice but let's you practice dentistry in a traditional way that is completely lost in cities. I have classmates who have to dance on social media. I'm so lucky to have been away from that chaos and not have to subject myself to that.

do you have any websites to share so I can look for those opportunites? Posts on Indeed is around 200k-250k for associates

 

[JacquesVallee]

do you have any websites to share so I can look for those opportunites? Posts on Indeed is around 200k-250k for associates

I found one of my jobs from DentalTown Classified ads. I found my other from my dental school who had people post job listings. Jobs might say "expect to make 200-250k" but in reality they are overly estimating how much you'll produce and you really would probably make 120-140k. You have to read the fine print. A guaranteed base of only 10k is insanely common, if not standard. You should find a job that guarantees something like 15k a month like I did. If you are genuinely willing to move anywhere, you will be able to find such a job and could even get some loan forgiveness as well depending on the need of the area and the state. However, expect your dating life (if your single) to take a major hit haha.

I practiced rural. My mentorship was FANTASTIC. My boss was so happy just to have me. I made great money and no joke paid only $800 a month for a nice two bedroom house to myself. In hindsight, I'm glad I did it to pay down my debt and learn how to be a dentist, but could've never stayed long term. Grind it out rural for five years then move wherever you want.

 

[TheLastDance]

do you have any websites to share so I can look for those opportunites? Posts on Indeed is around 200k-250k for associates

Lol. Never, ever trust salary income ranges on Indeed ads. Guess what, if the range says something ridiculous like "140-400K" as an income potential, you're getting paid 140-160K.

 

[JacquesVallee]

Lol. Never, ever trust salary income ranges on Indeed ads. Guess what, if the range says something ridiculous like "140-400K" as an income potential, you're getting paid 140-160K.

I saw a job posted on Indeed that said they paid $850 daily. So, I applied and interviewed. The true job offer was 8k a month guaranteed for six months or 30% production. Their former associate only produced 20-25k a month and he quit after just a few months. I never trusted another job posting after that.

 

[princeafrica]

. I have classmates who have to dance on social media.

😂

 

[dwn-test]

I preface this by saying no offense:

I couldn’t do general dentistry. For the most part, patients do not really appreciate what you do. You just did a perfect MODBL filling on 2 adjacent teeth on a patient? Often times they don’t care, and they don’t even know what that is. You just had perfect margins on a sub gingival crown prep? Again, patients don’t even know what that means. On average, the pay is crap compared to the amount of debt and time you put into it.

Nope, general dentistry is not for me.

what specialty did you pick

 

[HockeyDocOMFS]

what specialty did you pick

can you not feel sense their ego through the post? take a guess 😉. Best specialty ever, of course

 

[2TH MVR]

I truly believe that general dentistry is by far one of the hardest professions in the professional world. Not a physically demanding job, but a constant, unyielding mental burden. Every situation is a grey area. No black or white. Every restoration calls into your sense of what is done right and what could have been done better. Again. GREY areas. All these "questionable" restorations tests your sense of perfectionism. Day in. Day out.

Yeah. After a couple of years in dental school .... I decided to go into orthodontics. Less grey areas. I go home at night and sleep very well knowing I did my best for my patients. I rarely second guess my ortho procedures the next day. Easy to change course at the next ortho appt.

 

[JacquesVallee]

I truly believe that general dentistry is by far one of the hardest professions in the professional world. Not a physically demanding job, but a constant, unyielding mental burden. There are no GREY areas in general dentistry. Every restoration calls into your sense of what is done right and what could have been done better. Again. GREY areas. All these "questionable" restorations tests your sense of perfectionism. Day in. Day out.

Yeah. After a couple of years in dental school .... I decided to go into orthodontics. Less grey areas. I go home at night and sleep very well knowing I did my best for my patients. I rarely second guess my ortho procedures the next day. Easy to change course at the next ortho appt.

Very well stated. I couldn't agree more. Dentistry is so much harder than you realize as a pre dent. Exact reason I'm specializing.

 

[TanMan]

Is it? General dentistry as an associate (or even a bread and butter owner) is miserable if you're not rural. Have you genuinely worked in general dentistry PPO for multiple years in any urban environment? Corporate? Small office? In network? 90%+ of US dentist offices take PPO Delta/UHC/Cigna which 100% work directly against you to deny treatment/services you perform. This ruins your ability to run or sustain an office. Most offices geographically cannot afford to be OON or FFS. Most patients want an office that takes their insurance YoY. Insurance rates for general dentists are straight up robbery as an owner and this is before any expenses for staff, materials, HR/billing, building, or facilities. They deny your services on first billing but guess what, your bills still have to be paid.

The reality in 2025 is if you're not (1) owning OON FFS, (2) specializing, (3) being a Medicaid volume mill, or (4) partnering into a big group (with as little debt as possible) you're cooked working with insurance as a general dentist or an associate. Insurances have posted UCRs largely favoring specialists for better rates, better fee schedules, and better practice negotiations for the same larger/niche procedures that a general dentist could historically do for their clientele or was capable of doing for at a smaller fee in the past. Why do these harder specialty procedures when you're getting paid less? This forces people to go to specialists on referral because it's simply not worth the headache at any IN insurance level.

Even worse, the amount of value you have to provide at the general dentist practice level is unreasonably high. You're resigned as a general dentist to be unbelievably good at cosmetic makeovers + AOX + extremely heavy branding (take out an extra 100-200K in CE) to compete on a large-scale level which comes at a way bigger liability for your perceived skill level than ever before. There's a reason why OON and FFS is so out of reach for 9/10 dentists in this country.

Now if you're talking rural general dentistry? Totally different story, but comes with massive personal sacrifices if you're on your own (eg. loneliness).

This post seems to be a lot of doom and gloom. I'd probably perpetuate the same myth if I wanted to prevent other GPs from opening offices and make them work for me. Either you need to work on your billing/notes/documentation that you submit and/or work faster. All those things that you listed that you need are what those doing the CEs want you to think to buy into their courses. You would think that if these procedures were so profitable that those doing the CEs would focus more on practicing rather than doing CEs.

You can be in network with reasonable insurances as long as you can complete the procedures quickly and collect efficiently. Yeah, you will probably go broke if you take 30 minutes on an interproximal with PPO fees, 10 appointment dentures, or hour(s) long root canals and crowns. Solution? Either get faster or don't do them.

Lastly, you seem to hate the idea of being anywhere but a major city? Even in the suburbs or a municipality, you'll never be lonely unless your idea is to have crowds of people around you at all times, having a wife with 2.5 children, blah blah blah. You can have a companion/woman/girlfriend every day of the week in any part of the country, if you choose to do so.

General dentistry PPO for adults in a bread and butter model is cooked with insurance 100%. The small percent of GP dentists who do extremely well in this space are either legacy inheritance in a practice, children of wealthy parents to fund or support a startup/buyout, live in a remote area with a spouse that supports them, or straight up pay for 100-200K in CE to become a super GP doing the highest risk liability procedures. There is no middle ground associating or owning PPO if you're below the curve in any of these ways. There's a reason why specialties now are even harder to get.

I am neither of those categories and I'd like to think I'm doing well. Legacy inheritance is hit or miss, you don't need to be rich to have a startup, nor do you need to live in a remote area to make lots of money, or pay lots of money to be a super GP.

In a solo practice, you just need good marketing, have efficient systems, know how to talk to patients, and complete procedures quickly. Super GPs are overrated, you don't need to do everything as some of those "super GP procedures" actually take more time and devalue your hourly rate.

Anyway, I love being a GP because I can do easy cases. I don't need to do hard cases or clean up the messes of other dentists (maybe specialists, but that's a different story).

 

[JacquesVallee]

This post seems to be a lot of doom and gloom. I'd probably perpetuate the same myth if I wanted to prevent other GPs from opening offices and make them work for me. Either you need to work on your billing/notes/documentation that you submit and/or work faster. All those things that you listed that you need are what those doing the CEs want you to think to buy into their courses. You would think that if these procedures were so profitable that those doing the CEs would focus more on practicing rather than doing CEs.

You can be in network with reasonable insurances as long as you can complete the procedures quickly and collect efficiently. Yeah, you will probably go broke if you take 30 minutes on an interproximal with PPO fees, 10 appointment dentures, or hour(s) long root canals and crowns. Solution? Either get faster or don't do them.

Lastly, you seem to hate the idea of being anywhere but a major city? Even in the suburbs or a municipality, you'll never be lonely unless your idea is to have crowds of people around you at all times, having a wife with 2.5 children, blah blah blah. You can have a companion/woman/girlfriend every day of the week in any part of the country, if you choose to do so.


I am neither of those categories and I'd like to think I'm doing well. Legacy inheritance is hit or miss, you don't need to be rich to have a startup, nor do you need to live in a remote area to make lots of money, or pay lots of money to be a super GP.

In a solo practice, you just need good marketing, have efficient systems, know how to talk to patients, and complete procedures quickly. Super GPs are overrated, you don't need to do everything as some of those "super GP procedures" actually take more time and devalue your hourly rate.

Anyway, I love being a GP because I can do easy cases. I don't need to do hard cases or clean up the messes of other dentists (maybe specialists, but that's a different story).

I think the key to success as a GP comes from ownership. Being an associate really limits your income potential.

 

[TanMan]

I think the key to success as a GP comes from ownership. Being an associate really limits your income potential.

Yep, I think that's a given already.

 

[2TH MVR]

I think the key to success as a GP comes from ownership. Being an associate really limits your income potential.

Yep. Already a given as @TanMan said.
But the real question is. Are the new grads with their school debt able to successfully buy/open a private practice? Will banks lend money to these new dentists with a reasonable interest rate? Are the retiring dentists making it available for new grads to buy in as a partner or are they selling their practices to Dental Corps?

 

[TheLastDance]

Yep. Already a given as @TanMan said.
But the real question is. Are the new grads with their school debt able to successfully buy/open a private practice? Will banks lend money to these new dentists with a reasonable interest rate? Are the retiring dentists making it available for new grads to buy in as a partner or are they selling their practices to Dental Corps?

Answer is No and No.

 

[TanMan]

Yep. Already a given as @TanMan said.
But the real question is. Are the new grads with their school debt able to successfully buy/open a private practice? Will banks lend money to these new dentists with a reasonable interest rate? Are the retiring dentists making it available for new grads to buy in as a partner or are they selling their practices to Dental Corps?

Doing a startup doesn't require a loan and a lot of these practice loans comes with additional oversight and strings attached. Save up for a cheap startup and start producing as fast as possible. Why pay a price premium for an old practice, where the procedures have probably been drained for that patient pool.

 

[JacquesVallee]

Yep. Already a given as @TanMan said.
But the real question is. Are the new grads with their school debt able to successfully buy/open a private practice? Will banks lend money to these new dentists with a reasonable interest rate? Are the retiring dentists making it available for new grads to buy in as a partner or are they selling their practices to Dental Corps?

Even if they're able to, they won't. The data speaks for itself.

 

[charlestweed]

Doing a startup doesn't require a loan and a lot of these practice loans comes with additional oversight and strings attached. Save up for a cheap startup and start producing as fast as possible. Why pay a price premium for an old practice, where the procedures have probably been drained for that patient pool.

And it should be cheaper to start a specialty office because unlike GP office, a specialty office doesn’t have to be in highly visible area with high foot traffic. Therefore, you don’t need to pay big bucks to rent such space. I actually prefer my office to be inside a professional building because I don’t have to worry about the homeless people sleeping in front of my office, graffiti on my windows, cleaning the bathroom etc.

For a specialty office, you only need 1-2 chairs to start. You don’t even need to take out a loan for the office construction because you can just go around asking a GP if he wants to sublease his facility to you. That’s how I started mine. I used my wife office to start my ortho business. A year later when the office became too small for my patients, I moved my patients to a larger office space that I built from scratch. I currently have 3 offices. One of them was started from scratch and the other 2 belong to the GP owners, who let me rent their spaces.

Your success as a specialist depends on the relationship you have with the referring GPs. If you don’t like going door to door to introduce yourself to the GPs, then you shouldn’t specialize.

If starting an office is not your thing, you can just travel to work at multiple offices as in-house specialist….and get paid % of the production. A lot of my specialist friends (and I also) are doing this and they are very happy…..no need to go around meeting the referring GPs….no headache associated with running a business.

There are plenty of part time jobs available if you don’t mind working at multiple offices. For those of you who think going to multiple offices is hard….No, it’s not. It’s the same as going to work at 1 office location. I actually like going to different locations so I can try different restaurants. When I go to work at an office in the Little Saigon in the Westminster area (in So Cal), I usually have the delicious Pho soup for lunch. When I work at an office in Korea town, I usually get Tofu soup (BCD Tofu House is my favorite Korean restaurant chain) for lunch.

To answer the OP’s question…..I specialized in ortho because many of my classmates said it was a good specialty…good salary and lifestyle. I didn’t know anything about the specialty when I applied. The main reason for applying was I hoped I could make more as an ortho. I went to a Pass/Fail dental school that had very high specialty rate (about 75% of us specialized after graduation)…. it’s peer pressure.