If you could do it all over , would you still be a dentist ?

[charlestweed]

I'm not completely sure, but I think he could have been subtracting other overhead costs too. Maybe keeping his office open for 1 hour costs $55/hr (rent, supplies, electricity?), so it's $90 - $35 (hygeinist) - $55 (other overhead) = ~ $0 profit

What other overhead? the prophy paste and topical flouride only cost a few cents. He has to pay rent, electricity and other fixed expenses regardless he has patients or not.

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[theleatherwalle]

I am doing this from my phone so it may be a little difficult to tackle all the questions.

1. I came up with that figure by adding my salary and benefits as listed earlier. My salary was in 140s and we saw many patients with ppo plans

2. To quote the previous poster saying my overhead is about 55 dollars that is correct likely closer to 60 between rent, insurance, supplies, marketing, ect. I agree that it is unfair for me to blame the hygiene department, but I was particularly upset that day with them

3. I built my office from scratch. I had an opportunity to buy another office, but the dentist wanted too much money for it as he had become attached to the place. He has come back twice trying to sell the practice to me as a DSO office has eaten into his practice.

4. I believe we are slowly optimizing the practice so I doubt income will grow that much in 2020 if at all.

 

[charlestweed]

I am doing this from my phone so it may be a little difficult to tackle all the questions.

1. I came up with that figure by adding my salary and benefits as listed earlier. My salary was in 140s and we saw many patients with ppo plans

2. To quote the previous poster saying my overhead is about 55 dollars that is correct likely closer to 60 between rent, insurance, supplies, marketing, ect. I agree that it is unfair for me to blame the hygiene department, but I was particularly upset that day with them

3. I built my office from scratch. I had an opportunity to buy another office, but the dentist wanted too much money for it as he had become attached to the place. He has come back twice trying to sell the practice to me as a DSO office has eaten into his practice.

4. I believe we are slowly optimizing the practice so I doubt income will grow that much in 2020 if at all.

You built your office from scratch only 2 years ago and you have enough patients to hire a hygienist to work for you? That's pretty good. My sister has practiced dentistry for almost 20 years and she has done all the cleanings by herself because there are not enough patients to support a hygienist. Her office has always been a 1-doctor 1-assistant office. My wife comes in twice a month and I come in once a month to work as in-house specialists. I bring in my own ortho assistants, supplies and instruments.

 

[BYU4you]

To answer the original question:

As a fourth year dental student, matched into a 6yr-MD OMFS residency, I would not do it again. I am VERY lucky I found the OMFS field and matched. It is everything I want in a career and is really my dream job; however, I can't imagine what I would have done if I didn't match. Dentistry just isn't for me.

Knowing that, I would not have put all my eggs in one basket and risked a miserable life doing something I don't enjoy to get into OMFS. So to anyone who may be considering going through dental school solely for OMFS like I did, I don't recommend it. I would rather have gone the medical route and have many opportunities for specialties I would enjoy (albeit not as much as OMFS probably) vs the high risk-high reward route I took.

If anyone is reading this and really thinks they can do medicine and love the field, go for it. I fell in love with OMFS and convinced myself I could do dentistry as a backup "because the lifestyle" seemed nice. But that was really not the right mind frame. When you are shadowing dentists, really truly ask yourself if you could see yourself doing that for a living, if the answer is yes? Then it's truly a great profession.

With all this being said though, even if you fall in love with dentistry I still don't think I could recommend it to anyone unless they either had school paid for them or they have access to a cheap state school they are sure they can get into.

 

[ToothJockey]

To answer the original question:

As a fourth year dental student, matched into a 6yr-MD OMFS residency, I would not do it again. I am VERY lucky I found the OMFS field and matched. It is everything I want in a career and is really my dream job; however, I can't imagine what I would have done if I didn't match. Dentistry just isn't for me.

Knowing that, I would not have put all my eggs in one basket and risked a miserable life doing something I don't enjoy to get into OMFS. So to anyone who may be considering going through dental school solely for OMFS like I did, I don't recommend it. I would rather have gone the medical route and have many opportunities for specialties I would enjoy (albeit not as much as OMFS probably) vs the high risk-high reward route I took.

If anyone is reading this and really thinks they can do medicine and love the field, go for it. I fell in love with OMFS and convinced myself I could do dentistry as a backup "because the lifestyle" seemed nice. But that was really not the right mind frame. When you are shadowing dentists, really truly ask yourself if you could see yourself doing that for a living, if the answer is yes? Then it's truly a great profession.

With all this being said though, even if you fall in love with dentistry I still don't think I could recommend it to anyone unless they either had school paid for them or they have access to a cheap state school they are sure they can get into.

OMFS -> fail -> General Dentist
Ortho/Plastics/ENT -> fail -> Family Physician/Internal Medicine

Are you saying you would have rather taken the medicine route here? What if you failed to match a surgical specialty, would you have been happier as a family physician than as a general dentist?

 

[TanMan]

This response is a little off topic, but I will give some predents some numbers around my decision making process.

First dentistry is a top 10 career, but as my wife and I were doing our taxes I pulled out an old w2 from when i worked at a DSO
The following are real life numbers.

So I earned 187k the previous year which sounds like a lot of money, however 2 years ago I made 169k at my dso. I came to this figure by adding up my salary, 401k, bonus, healthinsurance, the portion business pay towards medicare and ss tax. So the grand difference between owning a practice vs working for someone is 18k a year. I believe in the future that gap will only shrink as more and more dentists go the DSO route+saturation. Even now, there is pressure on my hygiene department to break even! If I am paying someone 35 bucks an hour and delta dental is only paying me 90 dollars per hygiene check and each check on average is taking 45 minutes so that leaves very little room for profit. If I am running behind, or a patient is late or missing an appointment, or there is some issue we can likely be losing money.

Had i specialized i wouldn't have to deal with this much competition, marketing and all other parts of owning a business reliant on repeat customers, and had i established my practice earlier I would likely have lower rent, less money spent on marketing, a better trained staff with less turn over, and I could possibly negotiate higher rates with insurance companies.

If I was an endodontist I could literally work out of a shack or simply travel to offices and not deal with all the overhead I currently have.

If I may ask, are you single booking your hygiene patients? i.e 1 patient per hour? I find that some places have spoiled hygienists where they are "overwhelmed" with 2 patients an hour. Second, are you delegating tasks that could be delegated to assistants to your hygienist? Another inefficient practice I see are offices that make their hygienist take radiographs. Let your assistants do it to free your hygienist to do what they are legally able to (that assistants cannot - scaling/prophies)

I know what you mean by 90 dollars, the cheapest PPO plan, I get 89 dollars. However, I can run up to 7-10 columns of hygiene per hour (I can give up to 3 flexible rooms to my hygienist in case of overflow). Hygiene, in volume, can make a good amount of money. However, it's part of the good and the bad. It's bad because it's not as productive, but it's good because that's where your ops income comes from and very little time on your part. Your fixed/variable costs remain relatively constant whether you see 1 or 3 patients per hygienist per hour.

Specialists are at the whim of GPs, especially if they are very referral based. Grass will always look greener on the other side, but I think if done efficiently, GP is still the way to go. I'm a solo practitioner just like you and I have full faith that some solo practitioners can beat DSOs at their game if they play it smart.

 

[BYU4you]

OMFS -> fail -> General Dentist
Ortho/Plastics/ENT -> fail -> Family Physician/Internal Medicine

Are you saying you would have rather taken the medicine route here? What if you failed to match a surgical specialty, would you have been happier as a family physician than as a general dentist?

Not sure if that is the fairest comparison given there are a lot of other specialties between surgery and family medicine to choose from which is exactly why I would choose medicine. It's not as simple as OMFS> GP. But there are so many different fields of medicine to go into that aren't super competitive you don't have to do family medicine if you can't make it into to ENT. If I had to choose between the two, its tough. At the very least med school has more ways to get cheaper education to become a family medicine physician.

 

[Cold Front]

There’s a recent poll on dentaltown where 51% responded they’d choose another career if they could go back in time, 44% would do it again (back in times when debt was not as high), and 6% didn’t respond.

I think a lot of the 44% would not do it again if they had to pay current tuition levels, get paid with today’s reimbursement rates, and compete with DSOs, etc. So about 60% of practicing dentists who are active on dentaltown wouldn’t do it again.

Speaks volumes. The number of dental school applications have been declining the past few cycles. I think the word has already gone out about the high student debt levels from DS to many pre-dents who listened to practicing dentists in that 60% group. As a result, the odds of getting accepted to a dental school has become easier - specially with new schools opening every couple of years. Majority of dental schools will release their 2020-2021 tuitions next month - and it will probably be another record year for their cost of attendance across the board. Meaning, there will be more schools charging $500k+ a year than ever before for this coming cycle.


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[Saddleshoes]

Speaks volumes. The number of dental school applications have been declining the past few cycles. I think the word has already gone out about the high student debt levels from DS to many pre-dents who listened to practicing dentists in that 60% group. As a result, the odds of getting accepted to a dental school has become easier - specially with new schools opening every couple of years. Majority of dental schools will release their 2020-2021 tuitions next month - and it will probably be another record year for their cost of attendance across the board. Meaning, there will be more schools charging $500k+ a year than ever before for this coming cycle.

Well!
That would explain a couple of people I know that got in this time around!!!!

 

[2TH MVR]

Yep. Times have changed. It's easy to see the changes if you've been practicing for the last 27 years. Harder to see if you're new to dentistry. The dynamics have changed. It's more about survival against DSOs, working to pay off ridiculous DS debt, saturation, travelling specialists needing to take multiple jobs, GPs doing more and more specialty procedures, technology trying to kill off the ortho specialty, etc. etc.

Dentists cannot fight this. The main reason is that dentistry is a Mom and Pop business trying to make it in the Corporate arena. It's not just dentistry. Look around. The small businesses cannot compete with Corporate America. Private practice dentists are a small business with very little bargaining leverage. As a result .... everybody and everything is squeezing dentistry's profits.

There is one thing I have learned in dealing with big business (Corp America). EVERYTHING is written to protect them. Not the consumer.

OK. Enough doom and gloom. Hey. I bought a new putter yesterday. It works magically.

 

[ToothJockey]

Not sure if that is the fairest comparison given there are a lot of other specialties between surgery and family medicine to choose from which is exactly why I would choose medicine. It's not as simple as OMFS> GP. But there are so many different fields of medicine to go into that aren't super competitive you don't have to do family medicine if you can't make it into to ENT. If I had to choose between the two, its tough. At the very least med school has more ways to get cheaper education to become a family medicine physician.

I guess what I was trying to say is if you go into Med school with the goal of becoming an Ortho/Neuro/Plastic surgeon, and then you get clapped on Step 1, there goes your dreams down the drain. Sure you don’t have to do family med, you could maybe become a general surgeon, but I would think not achieving your goals would be devastating regardless of whether you went to dental or med school. Not to mention you only have 1 shot at Step 1 (i think), so your entire 40 year future depends on that 1 test on that 1 day.


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[Cold Front]

Well!
That would explain a couple of people I know that got in this time around!!!!

Even the well renowned and competitive 3-yrs DDS program at UOP costs a total of $520k before interest, or close to $600k with the compounding interest. The program is about to jack up their prices again (and San Francisco gets more expensive every year, it’s already expensive for people making a 6 figure income, let alone a dental student!). Any pre-dent applying to this school this coming cycle is looking at $650-700k minimum in student loans. Albeit they graduate 1 year early and make $150k pre-tax their first year.... it’s still too high!

Imagine the debt for the pre-dents applying to this program in 2030? Or in 2035? Or in 2040?


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[deleted903013]

Imagine the debt for the pre-dents applying to this program in 2030? Or in 2035? Or in 2040?

Do you think the bubble will have burst by then? NYU will cost one million dollars in the next few years and I can't imagine people will feel comfortable going into 7 figure debt for a 120k job. Then again, it's amazing people aren't phased by half a million dollars of debt.

 

[Cold Front]

Do you think the bubble will have burst by then? NYU will cost one million dollars in the next few years and I can't imagine people will feel comfortable going into 7 figure debt for a 120k job. Then again, it's amazing people aren't phased by half a million dollars of debt.

It depends. Like @2TH MVR said, it’s easy to see the changes over time. I graduate from d school 9.5 years ago, and my program was charging $60k a year total cost of attendance then. Today, it’s almost double. Did anyone in my school or anyone else could have predicted that 10 years ago? Probably not. It’s hard to see how high the cost of DS goes up from year to year, because - it’s only 3-5% increase y/y. But over time, that 3-5% compounding increases easily adds up to double the cost within a decade.

It’s pretty “normal” for a school to charge “$100k a year” today. I predict in 5-10 years, it will be “normal” for a school to charge “$125-150k a year”. Anyone who doesn’t believe me should read my posts on these forums in 5-10 years.

The bubble bursting. It’s going to happen. When? . Probably in 10-15 years. Half of that period is being undertaken by the current pre-dents/students who are currently freshmen in college.


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[ToothJockey]

I think the rule of debt = 2x starting income is pretty decent. I say that because the starting income is the only thing that's somewhat guaranteed. Whether you become a successful dentist is not guaranteed. So for a GP with starting income of 120k-160k, ideal debt levels would be 240k-320k or below. Any more debt, and your quality of life will suffer. 500k+ debt for a starting income of 120k-160k would give financially savvy people diarrhea. The unfortunate thing is unless you do military or have parents help, hitting the 240k-320k level is going to be tough moving forward. I don't really see starting income increasing either, it hasn't in over a decade, no reason for it to increase now.

 

[Cold Front]

I think the rule of debt = 2x starting income is pretty decent. I say that because the starting income is the only thing that's somewhat guaranteed. Whether you become a successful dentist is not guaranteed. So for a GP with starting income of 120k-160k, ideal debt levels would be 240k-320k or below. Any more debt, and your quality of life will suffer. 500k+ debt for a starting income of 120k-160k would give financially savvy people diarrhea. The unfortunate thing is unless you do military or have parents help, hitting the 240k-320k level is going to be tough moving forward. I don't really see starting income increasing either, it hasn't in over a decade, no reason for it to increase now.

I agree. Every pre-dent should watch this video before the apply to a dental school.

[youtube]


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[Combine33]

Different take here: I would do dentistry again no doubt. I come from a working class family that had no education. My brother and I are the first in our family to graduate from college. Dentistry gave me the opportunity, for an immigrant working class kid, to make it in America. That being said, I went to my state school for undergrad and dental school, and now I'm specializing. I've only been in private practice since July, so I dont know the trends, but even GP has been good to me. I encourage everyone I meet to join us and contribute to our dialogue. Dentistry gave me economic freedom that a lot of people take for granted.

 

[P7898]

Different take here: I would do dentistry again no doubt. I come from a working class family that had no education. My brother and I are the first in our family to graduate from college. Dentistry gave me the opportunity, for an immigrant working class kid, to make it in America. That being said, I went to my state school for undergrad and dental school, and now I'm specializing. I've only been in private practice since July, so I dont know the trends, but even GP has been good to me. I encourage everyone I meet to join us and contribute to our dialogue. Dentistry gave me economic freedom that a lot of people take for granted.

GP is good for anyone with a work ethic like yours. Keep up the good work.

 

[Combine33]

GP is good for anyone with a work ethic like yours. Keep up the good work.

I think thats the thing that get a lot of people. Ya gotta work to make it work. Sure GP may not be what it was 10, 20, even 30 years ago, but if you hustle while keeping your values and morals, I believe it'll stay worth it.

 

[yappy]

I think thats the thing that get a lot of people. Ya gotta work to make it work. Sure GP may not be what it was 10, 20, even 30 years ago, but if you hustle while keeping your values and morals, I believe it'll stay worth it.

The title of this thread is "If you could do it all over again...".

When I think about that prompt I consider what other opportunities were available given the amount of time, money, and energy I spent towards dentistry. You will work hard in any career. However, if you consider other fields like medicine it appears that dentistry is not great. I agree with you; dentistry is not a bad career. However, I am an optimizer by nature so I cannot help but consider more favorable alternatives.

To be clear: 8 years of education, significant debt (300-500k), to make 120k VS 30% of production is NOT a great deal. You must work very hard and be very wise with your finances to make that situation work.

 

[theleatherwalle]

The title of this thread is "If you could do it all over again...".

When I think about that prompt I think about what other career opportunities were available given the amount of time, money, and energy I spent towards dentistry. You will work hard in any career. However, if you consider other fields like medicine it appears that dentistry is not great. I agree with you; that dentistry is not a bad career. However, I am an optimizer by nature so I cannot help but consider more favorable alternatives.

To be clear: 8 years education, tons of debt (300-500k), to make 120k VS 30% of production is NOT a great deal. You must work very hard and be very wise with your finances to make it work.

I graduated with 270 grand of debt and was making 120k a year contract my first year. It was not a pleasant experience. Today's graduates are going to be drowning in a debt.

While dentistry is not quite what it use to be, I want to know which profession is trending up. outside of CRNAs, which im sure that party will end to when they hit saturation what is a better field?

And to answer Tan Man's question. We usually don't double book unless we know the patient well. I love that you can see dental practice inefficiencies, but not many dentists can work at your pace! I might be able to keep up with you on some procedures, but I've seen your schedule in another thread and there is no way I could keep up around your volume based practice!

 

[Cold Front]

To be clear: 8 years of education, significant debt (300-500k), to make 120k VS 30% of production is NOT a great deal. You must work very hard and be very wise with your finances to make that situation work.

Wouldn’t you say that about specializing as well? Additional $300k (on top of the 300-500k loans from DS) and make $350k pre-tax a year after residency? Not to mention the years it takes to build a good referral base. Medical school residency has no additional loans, you actually get paid and that’s a huge difference in my book.


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[charlestweed]

Wouldn’t you say that about specializing as well? Additional $300k (on top of the 300-500k loans from DS) and make $350k pre-tax a year after residency? Not to mention the years it takes to build a good referral base. Medical school residency has no additional loans, you actually get paid and that’s a huge difference in my book.


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At the beginning when their new offices are slow, they can travel to work at multiple GP (or corp) offices as in- house specialists to supplement their incomes. When I started my first office, I still kept my F/T jobs at 3 different corp offices and I only worked 2 saturdays and 1 Sunday a month at my own office. With those 3 weekend days/month at my own office, I could treat up to 300 patients.....and each patient paid me $110-150 per monthly office visit.

If the dentists put in the same amount of work hours as the physicians (ie 8-10 hours a day, working on weekends etc, doing paper works at home etc), they should earn similar incomes.

 

[yappy]

Wouldn’t you say that about specializing as well? Additional $300k (on top of the 300-500k loans from DS) and make $350k pre-tax a year after residency? Not to mention the years it takes to build a good referral base. Medical school residency has no additional loans, you actually get paid and that’s a huge difference in my book.


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I agree. It gets even worse: Gp docs earn more than gp dentists and, on average, have less debt. Medicine is the better path financially. I think there is a greater need (job opportunities) for physicians too.

 

[ToothJockey]

If the dentists put in the same amount of work hours as the physicians (ie 8-10 hours a day, working on weekends etc, doing paper works at home etc), they should earn similar incomes.

I guess the real question is, is there even enough work out there for a dentist to work as much as physicians do? Physicians are typically high in demand, there are way fewer physicians in the US than there are patients to treat. In some areas it takes 3-4 months+ just to book an appointment. Compare that to dentistry where a lot of dentists don’t even have enough patients for a full work week, that is evidenced by the busyness level surveys where 1/3 of dentists say they aren’t busy enough. Physicians OTOH are too busy



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[Anondds87]

The title of this thread is "If you could do it all over again...".

When I think about that prompt I consider what other opportunities were available given the amount of time, money, and energy I spent towards dentistry. You will work hard in any career. However, if you consider other fields like medicine it appears that dentistry is not great. I agree with you; dentistry is not a bad career. However, I am an optimizer by nature so I cannot help but consider more favorable alternatives.

To be clear: 8 years of education, significant debt (300-500k), to make 120k VS 30% of production is NOT a great deal. You must work very hard and be very wise with your finances to make that situation work.

Exactly. So many people say "oh if you do this and this and work extra you can pay 400k off in not too long".
And yes, that might be true if you live like a student etc, but its ignoring the fact that you still spent 400k on loans.
You could have done done something else at university and instead put that 400k (maybe not that much) invested and have passive income for the rest of your life constantly growing.
The opportunity cost with dentistry due to loans is so big. No one realizes until they graduate

 

[charlestweed]

I guess the real question is, is there even enough work out there for a dentist to work as much as physicians do? Physicians are typically high in demand, there are way fewer physicians in the US than there are patients to treat. In some areas it takes 3-4 months+ just to book an appointment. Compare that to dentistry where a lot of dentists don’t even have enough patients for a full work week, that is evidenced by the busyness level surveys where 1/3 of dentists say they aren’t busy enough. Physicians OTOH are too busy



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You can have busy schedule if you are willing to work hard. Accept plans that other dentists are not willing to accept (Medicaid, HMO), lower the tx fees, have convenient weekend/late office hours and the patients will come.

I am waiting to see my physician for an annual checkup right now. My copay is only $40. I wonder how much my Blueshield HMO pays my doctor.....probably not much. Doctors are busy but not every patient pays them.....many patients don't have insurance and doctors can't deny treatments.

 

[Cold Front]

if you are willing to work hard.

The million dollar question... “how many dentists are willing or are actually working hard?”.

I would wager less than half... considering majority of new grads from now on will be females; who want to get married and start a family within a decade after they graduate. They too have $500k+ student loans. The endgame is not pretty under those circumstances.

So “working hard” is easier said than done for majority of dentists. Life itself needs a lot of time and energy towards other personal obligations, and not just in career.


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[2TH MVR]

We've been discussing dentistry vs. medicine. No one has brought up medical vs. dental malpractice. That plays into this argument.

 

[Combine33]

We've been discussing dentistry vs. medicine. No one has brought up medical vs. dental malpractice. That plays into this argument.

Oh yea huge man. Where I practice in "the south" I pay approx. 2k/year for malpractice on a 2/4mil policy where I place implants and pull thirds. How much does a physician pay???

 

[ToothJockey]

Oh yea huge man. Where I practice in "the south" I pay approx. 2k/year for malpractice on a 2/4mil policy where I place implants and pull thirds. How much does a physician pay???

From what I’ve read online, some surgeons (neuro/ortho spine/CT/vascular) can pay 6 figure malpractice insurance, depending on the volume of surgeries they do. Those surgeries are pretty high risk I assume, so it makes sense.


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[mmc12]

From what I’ve read online, some surgeons (neuro/ortho spine/CT/vascular) can pay 6 figure malpractice insurance, depending on the volume of surgeries they do. Those surgeries are pretty high risk I assume, so it makes sense.


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Do the hospitals that they work in cover the cost of malpractice insurance?

 

[charlestweed]

The million dollar question... “how many dentists are willing or are actually working hard?”.

I would wager less than half... considering majority of new grads from now on will be females; who want to get married and start a family within a decade after they graduate. They too have $500k+ student loans. The endgame is not pretty under those circumstances.

So “working hard” is easier said than done for majority of dentists. Life itself needs a lot of time and energy towards other personal obligations, and not just in career.


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How hard should one be willing to work? How about working the same amount of work hours as the physicians? If you want to compare the salaries of the 2 fields, you have to look at the hourly wages.....apple to apple.

If you are not willing to work hard, then I would not recommend pursuing medicine either. I haven't yet seen a physician who works less than 30 hours a week and has 2 hour lunch like many of the dentists I know.

Don't want to work = no money.....very simple concept.

 

[ToothJockey]

The point that I was trying to make earlier is that, is it even possible for dentists to work 60 busy hours a week like physicians do? Just look at yourself Charles, you're one of the hardest working dentists out there, working 6 days a week, with a great business strategy treating a much wider range of patients than most dentists. However even with all that, I recall you said you work around 35 hours a week. Even with low fees and everything, do you think there is enough work/patients out there for you to work 60 hours a week?

I asked this question a few months ago too. Do dentists work 30-40 hrs/week by choice, or because there aren't enough patients to treat for 50+ hrs/week?

 

[theleatherwalle]

The point that I was trying to make earlier is that, is it even possible for dentists to work 60 busy hours a week like physicians do? Just look at yourself Charles, you're one of the hardest working dentists out there, working 6 days a week, with a great business strategy treating a much wider range of patients than most dentists. However even with all that, I recall you said you work around 35 hours a week. Even with low fees and everything, do you think there is enough work/patients out there for you to work 60 hours a week?

I asked this question a few months ago too. Do dentists work 30-40 hrs/week by choice, or because there aren't enough patients to treat for 50+ hrs/week?

I work 36-38 clinic hours a week. I believe there is plenty of work out there, but most patients cannot afford care or most insurance policies pay so little that you're essentially forced to upbill due to "combination coding" and hope you the "right" payer mix

 

[charlestweed]

The point that I was trying to make earlier is that, is it even possible for dentists to work 60 busy hours a week like physicians do? Just look at yourself Charles, you're one of the hardest working dentists out there, working 6 days a week, with a great business strategy treating a much wider range of patients than most dentists. However even with all that, I recall you said you work around 35 hours a week. Even with low fees and everything, do you think there is enough work/patients out there for you to work 60 hours a week?

I asked this question a few months ago too. Do dentists work 30-40 hrs/week by choice, or because there aren't enough patients to treat for 50+ hrs/week?

By choice. Right now, I can work more days and more hours if I want to. Not too long ago, the corp mananger asked me if I could work at more office locations but I told her that the current 11days/month is the maximum number of days I can work for the company. And she joked with me: "Doc, I wish I could clone you."

When I was still in my early 30s and my kids were only 1-2 years old, I worked 50-60 hours a week. As I mentioned earlier, I didn't want to quit my F/T job at the corp when I set up my own office. In addition to the 3 weekend days working at my own office, I also worked from 6:30pm-9pm on a few weekdays. As soon as I finished my job at the corp at 6pm, I drove straight to my newly build office to work there until 9pm. My wife also came to help me both in the front and back.

When my sister started her office, she worked 7 days/week: 3 days/week (including Saturdays and Sundays) at her own office and 4 days/week for the same corp office that I also worked for. And she is practicing in very saturated market in CA. Yes, CA was saturated 20 years ago.

I am 48 now. 33-35 hours a week is enough for me. I only have the home loan left to pay back and it should be paid off by the end of this year. My kids are getting older and I need to spend more time them. They will be in college in 2-3 more years.

 

[charlestweed]

I work 36-38 clinic hours a week. I believe there is plenty of work out there, but most patients cannot afford care or most insurance policies pay so little that you're essentially forced to upbill due to "combination coding" and hope you the "right" payer mix

Yup, there are plenty of work out there for dentists. The question is how hard is he/she is willing to work? Dentists can have fully booked schedule like the corp offices if they are willing to accept all types of insurance plans like the corp offices. More patients will come when your fees are affordable.If there are not enough patients at your own office, you can keep yourself busy by working P/T as an associate at another office. Whenever you feel you make enough and get tired of seeing high patients volume, you can always drop those low pay insurance plans and raise your fees.

Where there's a will, there's a way.

 

[Cold Front]

Don't want to work = no money.....very simple concept.

Just like anything else, working hard comes with a bell curve. The stats tell us that most new grads are associating in their prime years (20s and 30s) - due to student loans debt and starting a family. When they reach late 30’s to mid-40’s, the majority are exhausted and start watching their posture and stop taking risks with their bodies... so their “working hard” days are now numbered from there, if any.

Also, you are an orthodontist, so working hard as an orthodontist vs a general dentist are clearly apples and oranges. Would be nice to hear from general dentists above age 45 who are working hard - like 50+ hours a week, as Charles recommended. I’m 40 yr old general dentist, and I think @TanMan is about my age... and I think he would agree the working hard rule is not a ubiquitous and continuous thing for general dentists.



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[AONLINE]

This was released today: 100 Best Jobs of 2020. Our profession is ranked at #2 after Software Developer, which is not too different from the previous years. Median salary listed is $151k. I know that dentists on SDN tend to disagree with this ranking.

 

[charlestweed]

Just like anything else, working hard comes with a bell curve. The stats tell us that most new grads are associating in their prime years (20s and 30s) - due to student loans debt and starting a family. When they reach late 30’s to mid-40’s, the majority are exhausted and start watching their posture and stop taking risks with their bodies... so their “working hard” days are now numbered from there, if any.

That's why it's important to do everything early. If one stays focused in school, he/she should get his DDS by the age of 26. And after 20 years of hard work, at 46, his student loan debt of $4-500k should be paid off and he should be able to work less hours like you and me. If he can't do that in 20 years, there must be something wrong with his work ethic and his spending habit.

My cousin is 47 yo. He is a MD anesthesiologist. He is still working 40+ hours a week. He doesn't have a choice to work less hours. His job is to save people's lives. He wishes he could have the dentist's work hours like me. He graduated the same time with me and he can't afford to get a house in Orange County, CA, where the average home price is around $5-600k. His wife is not a stay home mom. She is an optometrist.

Also, you are an orthodontist, so working hard as an orthodontist vs a general dentist are clearly apples and oranges. Would be nice to hear from general dentists above age 45 who are working hard - like 50+ hours a week, as Charles recommended. I’m 40 yr old general dentist, and I think @TanMan is about my age... and I think he would agree the working hard rule is not a ubiquitous and continuous thing for general dentists.

Working as an ortho is definitely a lot easier than working as GP. That's the reward for staying in school 2-3 years longer and for taking the risk of borrowing extra loan for ortho residency.

Tanman is working extremely hard. He does everything by himself. He moves from chair to chair all day long. He doesn't hire any associate dentist. Unlike most dentists, he works on Saturdays and Sundays. He deserves to retire earlier than most of the colleagues at his age.

 

[Cold Front]

That's why it's important to do everything early. If one stays focused in school, he/she should get his DDS by the age of 26. And after 20 years of hard work, at 46, his student loan debt of $4-500k should be paid off and he should be able to work less hours like you and me. If he can't do that in 20 years, there must be something wrong with his work ethic and his spending habit.

I don’t want many people reading our posts to think we are tone deaf, but you and I are first generation immigrants who think and work differently than majority of new dentists. What new grads “should do” and what they “will do” are two different things.

So let’s look at your 20 years theory: to pay off student loans of $4-500k in 10 years, it’s $5k a month payment (post tax), at a $10-12k a month (post tax) income. Cost of living could easily take another $3-5k/month depending where you live in the country. You would be down to $2-3k a month at best to save (for retirement or rainy day). The debt to income ratio would be too high to get a practice loan. So you associate for 10 years to pay off all your student loans from age 25-35. Let’s assume no marriage or buying a home or any other major purchases in this period.

The next 10 years (age 35-45): You get a practice loan $200-300k, and increase income to $350k a year (probably not in the first year or 2), and it takes about 3-5 years to pay off that practice loan, by age 40. Now “the body” needs to slow down and the office hours will definitely change to 4 days a week as an owner, but the income will dip to $250-300k a year - almost down to the first decade income. So you are looking at $12-15k a month post tax with no practice debt or student loans, but wait - there is still a mortgage loan, cost of having a family and serious retirement savings hurdles to go through. All of this is assuming the taxes don’t go up.

Basically, that 20 years plan is not long enough. You still need 10 years minimum to pay off every debt possible the average dentist can have. This easily takes you to age 55 - and you could still have college cost bills for your kids. That’s cutting it very close to the ideal retirement age of 60, a life spent of keeping your head above water - through dentistry. Again, I’m speaking through the lens of the “average dentist”.

Meanwhile - another wild factor, 50% of dentists are projected to work for DSO’s in 5-10 years by people on DentalTown and most dentists in general.

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[charlestweed]

I don’t want many people reading our posts to think we are tone deaf, but you and I are first generation immigrants who think and work differently than majority of new dentists. What new grads “should do” and what they “will do” are two different things.

So let’s look at your 20 years theory: to pay off student loans of $4-500k in 10 years, it’s $5k a month payment (post tax), at a $10-12k a month (post tax) income. Cost of living could easily take another $3-5k/month depending where you live in the country. You would be down to $2-3k a month at best to save (for retirement or rainy day). The debt to income ratio would be too high to get a practice loan. So you associate for 10 years to pay off all your student loans from age 25-35. Let’s assume no marriage or buying a home or any other major purchases in this period.

The next 10 years (age 35-45): You get a practice loan $200-300k, and increase income to $350k a year (probably not in the first year or 2), and it takes about 3-5 years to pay off that practice loan, by age 40. Now “the body” needs to slow down and the office hours will definitely change to 4 days a week as an owner, but the income will dip to $250-300k a year - almost down to the first decade income. So you are looking at $12-15k a month post tax with no practice debt or student loans, but wait - there is still a mortgage loan, cost of having a family and serious retirement savings hurdles to go through. All of this is assuming the taxes don’t go up.

Basically, that 20 years plan is not long enough. You still need 10 years minimum to pay off every debt possible the average dentist can have. This easily takes you to age 55 - and you could still have college cost bills for your kids. That’s cutting it very close to the ideal retirement age of 60, a life spent of keeping your head above water - through dentistry. Again, I’m speaking through the lens of the “average dentist”.

Meanwhile - another wild factor, 50% of dentists are projected to work for DSO’s in 5-10 years by people on DentalTown and most dentists in general.

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Why do you think people who were born and raised here cannot work like us, first generation immigrants? Isn't 40 hours/week the typical number of work hours for most American workers? So why can't dentists do the same? So I guess American born people should not go into medicine either because most are required to work 40+ hours a week during and after their residencies.

Why do you always have to make the worst assumptions? ie working as an associate for 10 years before starting a practice, borrowing $2-300k loan to set up practice etc, cutting down to 4 days/week when reaching the age of 40 etc. Most dentists I know starting their own offices a lot sooner than 10 years (you, Tanman, Theleatherwalle, Rainee etc). Tanman is working 4 days/week but he puts in a lot more effort per work day than people who work 5-6 days/week....and it's called efficiency.

Sure, there are dentists who struggle either because they are unwilling to work hard or because they don't have the right business skills but there are also dentists who have done very well. Work hard, don't be an "average" dentist. Just like when you are in school, don't be an "average" student.

 

[TanMan]

Exactly. So many people say "oh if you do this and this and work extra you can pay 400k off in not too long".
And yes, that might be true if you live like a student etc, but its ignoring the fact that you still spent 400k on loans.
You could have done done something else at university and instead put that 400k (maybe not that much) invested and have passive income for the rest of your life constantly growing.
The opportunity cost with dentistry due to loans is so big. No one realizes until they graduate

As I always say, if you're going to "invest" in yourself via education, you better have a good plan to justify that investment. In hindsight, if I knew what I knew now, I would take on 1M in debt just to get where I'm at now. I'm probably going to get blasted for that statement. However, just like averages, we have to look at averages, assuming that the person receiving the advice is average. I think that MIGHT be the problem is that everyone thinks they are above average, but for there to be an average, there has to be some that are below average. Know yourself before you invest in yourself.

The point that I was trying to make earlier is that, is it even possible for dentists to work 60 busy hours a week like physicians do? Just look at yourself Charles, you're one of the hardest working dentists out there, working 6 days a week, with a great business strategy treating a much wider range of patients than most dentists. However even with all that, I recall you said you work around 35 hours a week. Even with low fees and everything, do you think there is enough work/patients out there for you to work 60 hours a week?

I asked this question a few months ago too. Do dentists work 30-40 hrs/week by choice, or because there aren't enough patients to treat for 50+ hrs/week?

I work 33 hours a week by financial choice. It is what the market demands. I used to open more hours, but found that the gain per hour incrementally decreases. Opening more hours doesn't mean more money. Your variable expenses/labor costs go up the more hours you are open. Labor takes up a large chunk of your operating expenses. Also, I'm already tired at working 33 hours. However, I work non-stop though. I don't eat breakfast or lunch (no snacks/drinks) and rarely use the bathroom during work. I don't think I would have it any other way though. Working 40-60 hours and having downtime between just feels like torture.

Plenty of work for 50-60 hours, but I'd rather condense it down to less hours. Less hours at the office, less staff hours, more time to rest.

Just like anything else, working hard comes with a bell curve. The stats tell us that most new grads are associating in their prime years (20s and 30s) - due to student loans debt and starting a family. When they reach late 30’s to mid-40’s, the majority are exhausted and start watching their posture and stop taking risks with their bodies... so their “working hard” days are now numbered from there, if any.

Also, you are an orthodontist, so working hard as an orthodontist vs a general dentist are clearly apples and oranges. Would be nice to hear from general dentists above age 45 who are working hard - like 50+ hours a week, as Charles recommended. I’m 40 yr old general dentist, and I think @TanMan is about my age... and I think he would agree the working hard rule is not a ubiquitous and continuous thing for general dentists.



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I'll agree with you that many general dentists are lazy AF. I'm not as old as you, but I can feel it a little bit already. I'm 35 now, sigh.

Why do you think people who were born and raised here cannot work like us, first generation immigrants? Isn't 40 hours/week the typical number of work hours for most American workers? So why can't dentists do the same? So I guess American born people should not go into medicine either because most are required to work 40+ hours a week during and after their residencies.

Why do you always have to make the worst assumptions? ie working as an associate for 10 years before starting a practice, borrowing $2-300k loan to set up practice etc, cutting down to 4 days/week when reaching the age of 40 etc. Most dentists I know starting their own offices a lot sooner than 10 years (you, Tanman, Theleatherwalle, Rainee etc). Tanman is working 4 days/week but he puts in a lot more effort per work day than people who work 5-6 days/week....and it's called efficiency.

Sure, there are dentists who struggle either because they are unwilling to work hard or because they don't have the right business skills but there are also dentists who have done very well. Work hard, don't be an "average" dentist. Just like when you are in school, don't be an "average" student.

Dead on. People seem to tout that formula above and I think it's a stupid myth perpetuated by some people who have some vested interest in keeping dentists as indentured servants. I tout a different formula... work hard, save up for an office, minimize debt payments, start cheap, pay for an office in cash (with money saved from working hard, minimize lifestyle expenses, not paying your debt down immediately), start marketing/making lots of money, pay off debts afterwards or invest more. As long as your debt to income ratio is not unsustainably high in the long term, you have some control over that ratio. That means working hard to make more money to be able to boost that income even more to the point where it overshadows your debt. If the debt is "cheap enough", (i.e 0% or below inflation), keep the debt as long as it doesn't hamper your ability to accumulate more debt for investments.

Maybe I'm a crazy risk taker, but that's my take on maximizing profitability. I find it appalling that people seem so focused on the debt when they should really be focused on the income. I wish I could work 5-6 days a week, but I am tired at the end of the week. My hands and eyes need recuperation

 

[Cold Front]

Why do you think people who were born and raised here cannot work like us, first generation immigrants? Isn't 40 hours/week the typical number of work hours for most American workers? So why can't dentists do the same?.

On average, the motivation is different.

Immigrants are motivated because they left their former countries of citizenship, or habitual residence, for a variety of reasons, including a lack of local access to resources, a desire for economic prosperity, to find or engage in paid work, to better their standard of living, etc. One could argue everyone is essentially an immigrant in this country, but the first generation immigrants are by far the most motivated to learn and most eager to succeed in life - compared to second, third and fourth generations. Again, not to take anything away from all hard working people in this country, but the macro stats speak for themselves.

It’s also no surprise that nearly half of Fortune 500 companies were founded by immigrants or their kids. Everyone can work hard - but first immigrants have a different perspective, a second chance, a fresh start - which leads to a psychologically and emotionally charged approach to everything. This applies to dentists as well.


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[charlestweed]

On average, the motivation is different.

Immigrants are motivated because they left their former countries of citizenship, or habitual residence, for a variety of reasons, including a lack of local access to resources, a desire for economic prosperity, to find or engage in paid work, to better their standard of living, etc. One could argue everyone is essentially an immigrant in this country, but the first generation immigrants are by far the most motivated to learn and most eager to succeed in life - compared to second, third and fourth generations. Again, not to take anything away from all hard working people in this country, but the macro stats speak for themselves.

It’s also no surprise that nearly half of Fortune 500 companies were founded by immigrants or their kids. Everyone can work hard - but first immigrants have a different perspective, a second chance, a fresh start - which leads to a psychologically and emotionally charged approach to everything. This applies to dentists as well.


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Hopefully, when today and future grad dentists are challenged with the large student loan debt (which is just like the financial hardship that many first generation immigrants have to face), they will be motivated to work hard to get themselves out of poverty and debts. Americans are hard working people and this is why this country is the best country in the world. In many other poor developing countries, people don’t work 8 hours a day….many take a nap in the middle of the day.

 

[Cold Front]

In many other poor developing countries, people don’t work 8 hours a day….many take a nap in the middle of the day.

Not really. That’s because job opportunities in many developing countries are next to 0. Some nations are just too wealthy and their people get subsidies that covers all their bills and more. There are a lot of dentists overseas who work harder than the average dentist in the US and still have second and third jobs to make ends meet. They would drive Uber or work in restaurants after they see their patients during the day. Many foreign medical doctors in this country who can’t get into a residency program work in warehouses and do other regular jobs - the system can’t just take all of them to become doctors. Meanwhile, we have about 5 million Americans in their prime years who choose not to work (some play video games all day).

My neighbors invited my wife and I to have a dinner with them at a nice restaurant couple of week ago. When the waitress gave us the bill - she noticed the business card I used at this restaurant had the title DMD next to my name. To my surprise - she said she was a dental hygienist and her waitress gig was her second job. I don’t know exactly how she ended up at this high end restaurant, but just shows the assumption of working hard in the dental field has more to it and doesn’t apply to everyone - specially for a dental hygienist to be working as a waitress (which is a hard job). Maybe she was a mother with a significant debt/student loans and couldn’t support her family with a dental hygienist income.

It’s wrong to think - that people should either work hard or be lazy to decide how society views them as individuals - which is a very abstract analysis to me. Hard work needs a special sauce to be successful, and in the case of dentists, getting yourself into a lot of debt and graduating from dental school alone does not make a new grad to have a successful career in dentistry. You need to have ambition and drive more than anything, more than being a dentist itself - the actual difference between the haves and have-nots in society.


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[2TH MVR]

We've been discussing dentistry vs. medicine. No one has brought up medical vs. dental malpractice. That plays into this argument.

What I was really referring to is the emotional stress dealing with lawsuits ....not just the premiums. I could be wrong, but it seems that the medical profession is exposed to many more lawsuits than the dentists. I've been involved in ONE frivolous malpractice suit. It lasted for almost a year and was emotionally draining. I would NEVER want to go through that again. As a result ... I practice DEFENSIVE dentistry 100% of the time. Just sayin that medicine is probably more exposed than dentistry.

Just like anything else, working hard comes with a bell curve. The stats tell us that most new grads are associating in their prime years (20s and 30s) - due to student loans debt and starting a family. When they reach late 30’s to mid-40’s, the majority are exhausted and start watching their posture and stop taking risks with their bodies... so their “working hard” days are now numbered from there, if any.

Also, you are an orthodontist, so working hard as an orthodontist vs a general dentist are clearly apples and oranges. Would be nice to hear from general dentists above age 45 who are working hard - like 50+ hours a week, as Charles recommended. I’m 40 yr old general dentist, and I think @TanMan is about my age... and I think he would agree the working hard rule is not a ubiquitous and continuous thing for general dentists.

How hard should one be willing to work? How about working the same amount of work hours as the physicians? If you want to compare the salaries of the 2 fields, you have to look at the hourly wages.....apple to apple.

If you are not willing to work hard, then I would not recommend pursuing medicine either. I haven't yet seen a physician who works less than 30 hours a week and has 2 hour lunch like many of the dentists I know.

Don't want to work = no money.....very simple concept.

Charles. Everyone agrees that to get anywhere you have to work hard. I can't speak for anyone else, but in my professional career (last half) .... IVE HAD TO WORK HARDER AND MAKE LESS MONEY. You even stated that you get no Corp raises, but I'm sure the work load remains. You're successful from a monetary sense because you work really hard, put in very long hours, kept your overhead ridiculously low ... therefore you make money. But there will come a time where hard work will not be enough. There will be a limit to how low your fees will be and how low your OH can be. That's a fact.

My point is that it shouldn't be this way. This trend of more work, less pay is not sustainable in any profession nor would it be desirable. In the end ... you make less money and the patient's care will be possibly compromised.

 

[theleatherwalle]

hard. I can't speak for anyone else, but in my professional career (last half) .... IVE HAD TO WORK HARDER AND MAKE LESS MONEY. You even stated that you get no Corp raises, but I'm sure the work load remains. You're successful from a monetary sense because you work really hard, put in very long hours, kept your overhead ridiculously low ... therefore you make money. But there will come a time where hard work will not be enough. There will be a limit to how low your fees will be and how low your OH can be. That's a fact.

My point is that it shouldn't be this way. This trend of more work, less pay is not sustainable in any profession nor would it be desirable. In the end ... you make less money and the patient's care will be possibly compromised.

This is simple supply and demand. Currently there is more supply for dentist than demand! right now every dentist has a job who wants 1. I highly doubt that will be the case in the 5 years! Technology is also changing how we do dentistry rapidly.

 

[DaviBR]

That’s because job opportunities in many developing countries are next to 0

That's true. Brazil have a huge number of dentists and it gets worse every year with more and more DS opening. It's a very saturated market and, what confort me the most is that, if you work really hard and specialize, you have some chance to make it. Plus, you can get 100% scholarships, so no debt to pay (wich I think it's the main reason why some people here said it's no worth in the US). While reading the topics here and seeing that many recent graduates gets job offers straight out of DS I was amazed.

 

[beannaithe]

I haven't read the whole thread, but I would not become a dentist again. Don't get me wrong. I do well financially and have a great work/life balance as a part-time associate. But I lost 4 years of income and had huge student loans.

Insurance reimbursements have tanked. They're denying more work and creating more paperwork for us to get work covered. We had to write narratives for a while just to get PAs covered. A narrative for an x-ray reimbursed at $11. Patients are more demanding and expect free stuff if their insurance doesn't cover it. Patients get upset if they wait more than 5 minutes in the waiting room. There is a lot of competition from other dentists due to saturation. I've been thrown under the bus by a guy down the street for a crown. There is also a lot of wear and tear on your body.

It's been more work and stress for less pay. I'm working harder to make the same hourly rate I did 5 years ago. I imagine it is much harder as an owner because there is staffing issues, keeping up with office issues, and lots of "hidden" costs to practice.