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

[Cold Front]

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.

Imagine all the issues you mentioned getting worse in the future for future dentists who carry 3-4x more student loans debt than you did. It’s all a race to the bottom.


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[beannaithe]

Imagine all the issues you mentioned getting worse in the future for future dentists who carry 3-4x more student loans debt than you did. It’s all a race to the bottom.


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Sadly, it seems that way. We saw an insurance cut reimbursements by 20% a few years ago, some of the others followed suit the following year. Now, we are back to the standard 1% increase every year. We're still getting reimbursed at levels less than when I graduated now. Insurance usually covers crown/denture replacements every 5 years. I saw the first one yesterday that covered a replacement once every 10 years. It will be interesting to see what comes as we go forward.

 

[charlestweed]

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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Other countries are wealthy because of their natural resources. Some countries have good natural resources but remain poor because of their corupted governments. America is wealthy because of the hard working American people, the 3 equal branches of government that we have in place, and capitalism which encourages innovation. Capitalism has created job opportunities and wealth in America.

When people have good jobs, good dental insurances and money, they care more about their teeth. That's why we, American dentists, are super wealthy in comparison to dentists in other countries. Back in the 60s, only people with severe malocclusion and crooked teeth got braces. Now virtually every teenager gets braces. Braces have become an entitlement. Parents are saving up money for their kids' ortho tx. And that's good for us, American orthodontists.

Just look at the olympic opening ceremonies, beside having the highest number of partidcipating athletes, American athletes also have the most beautiful teeth, most beautiful hairstyles and makeup. Look at the US women soccer team, all the players have beautiful smiles.

Oh, about the story of the hygienist, who works P/T as a waitress......to you, waiting tables is a hard job but to her, it may be a good supplemental income. In HS, I worked as a busboy and had the opportunity to be around with the waiters and waitresses. These waiters/tresses got more than $100 a day in tips, which was more than what an engineer made at that time. And they only shared with me $4-5 of their tip money. I applaud that hygienist for her hard work.

 

[charlestweed]

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.

I make less now because I don't work as hard as I once did. With less debt, I've become less motivated to work hard. I stopped going door to door to meet the referring GPs. I stopped writing the tx report to my referring GPs. I actually take home more money now despite lower income from doing orthodontics. That's because I have no more debt (except for the home mortgage) to pay back and the passive income from my rental investments.

I didn't ask the corp, that I work for, for a raise because I didn't feel I deserve a raise. My corp has lost a lot of patients because the company keeps opening new offices.....their offices are essentially competing among themselves for the same pool of patients. As a result, I see much less patients than I did 10 years ago. I actually asked the corp to cut down my days but they didn't want to....they were ok with paying me for sitting around doing nothing and that's fine with me. It's easy money.

I can add more work days at the corp and make more money if I want to. The corp want me to work at some of their new offices that they recently built. But I think the current 22 work days a month is more than enough for me. I am thinking of hiring one more P/T assistant so I can treat more patients in a day and eliminate 1 Saturday at one of my offices.

 

[charlestweed]

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.

Then what other profession you would pursue that allows you to have a great work/life balance that you currently enjoy now? What other profession that allows you to work P/T and still make a 6-figure income like dentistry?

 

[charlestweed]

Sadly, it seems that way. We saw an insurance cut reimbursements by 20% a few years ago, some of the others followed suit the following year. Now, we are back to the standard 1% increase every year. We're still getting reimbursed at levels less than when I graduated now. Insurance usually covers crown/denture replacements every 5 years. I saw the first one yesterday that covered a replacement once every 10 years. It will be interesting to see what comes as we go forward.

I remember when I came to see my uncle, who is a foreign trained MD, to obtain a letter of recommendation from him for my dental school applications, he showed me a check that he got from an HMO insurance company. He complained to me his HMO check got smaller than before. He said to me that my generation would not do as well as the doctors of his generation. At that time, I didn't know what he was talking about.....I just wanted to get into dental school. And here we are, 20+ years later........still complaining about the insurance companies that continue to cut their pays to dentists and doctors.

 

[beannaithe]

Then what other profession you would pursue that allows you to have a great work/life balance that you currently enjoy now? What other profession that allows you to work P/T and still make a 6-figure income like dentistry?

To be honest, I haven't truly thought about it. When considering the cost of admission (tuition cost and years lost income), the break-even point for dentistry being a "good deal" becomes razer thin. I freely admit I have a unicorn associateship. I doubt I'd ever be lucky enough to find another part time job in dentistry that pay 6 figures again.

 

[beannaithe]

I remember when I came to see my uncle, who is a foreign trained MD, to obtain a letter of recommendation from him for my dental school applications, he showed me a check that he got from an HMO insurance company. He complained to me his HMO check got smaller than before. He said to me that my generation would not do as well as the doctors of his generation. At that time, I didn't know what he was talking about.....I just wanted to get into dental school. And here we are, 20+ years later........still complaining about the insurance companies that continue to cut their pays to dentists and doctors.

I think doctors will always complain that we don't get paid enough by insurance. It's just crazy to think reimbursements are lower now than when I graduated 10 years ago. Just means more work for less money.

 

[Cold Front]

Oh, about the story of the hygienist, who works P/T as a waitress......to you, waiting tables is a hard job but to her, it may be a good supplemental income. In HS, I worked as a busboy and had the opportunity to be around with the waiters and waitresses. These waiters/tresses got more than $100 a day in tips, which was more than what an engineer made at that time. And they only shared with me $4-5 of their tip money. I applaud that hygienist for her hard work.

No. The point I was making was - the waitress took out student loans to go to a Hygiene school full time and planned to work in that field for a good ROI on her investment (time and debt), but obviously the plan fell short because she had to take a second job to support herself. It’s not about the waitress job or what she makes from it, but more about the state of hygiene field and their new grads not being able earn enough income to support themselves and their student loans. Many cities have a surplus of hygienists, more than dentists, so it’s obvious to see dental hygienists moonlighting in other job markets for extra income.


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[charlestweed]

No. The point I was making was - the waitress took out student loans to go to a Hygiene school full time and planned to work in that field for a good ROI on her investment (time and debt), but obviously the plan fell short because she had to take a second job to support herself. It’s not about the waitress job or what she makes from it, but more about the state of hygiene field and their new grads not being able earn enough income to support themselves and their student loans. Many cities have a surplus of hygienists, more than dentists, so it’s obvious to see dental hygienists moonlighting in other job markets for extra income.


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Dental hygiene is very saturated.....much worse than dentistry. When I was still in dental school, there were only 3 dental hygiene programs (LLU, USC, and West LA college) in the entire southern California. Now there are at least 8 hygiene programs. Here in CA, most Asian dentists don't hire hygienists because they do their own cleanings. At least being a dentist, one can open an office and has the potiential to become sucessful like you and Tanman. The hygienists can't do that in most states....they have to work under the supervision of the dentists.

 

[ToothJockey]

To be fair, not many aspiring dentists want to become a hygeinist I would assume. We go into dentistry to be the boss, have the final say over a treatment plan, do a wide range of procedures. Hygiene won't be a satisfying career for many of us. I think a good alternative to dentistry is medicine.

If you want to skip healthcare in general, then CS/Finance/Banking/Engineering generally has favorable financial outcomes with less than 1/5 the debt, and these fields can be intellectually stimulating as well, similar to dentistry I would assume.

 

[TanMan]

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.

Insurance reimbursements have definitely stagnated, but I think this is where a lot of offices/practitioners fail to adapt.
How do we combat lower insurance reimbursements?
1. We do not have much say in what insurance pays, we can try and renegotiate, but some insurers are so big, they don't need to negotiate.
2. Become more efficient time/procedure-wise or delegate to higher paid in-house specialists if you have enough work to go around (i.e you got enough crowns to keep you busy that you don't need to do endos)
3. Lower overhead

Number 2/3 are the most practical to work on, However, you can only lower your overhead so much until efficiency/quality is affected. Therefore, number 2 is going to be the most important point to work on.

On your PA example, Either I write it off or charge the patient. If the patient is willing to pay for fluoride, they are willing to pay for a PA. Otherwise, if they can't or don't want to pay for the PA, they are probably not going to get treatment, if it's due to financial reasons. Personally, I'm not going to going to grasp at straws writing a narrative for a PA. Time is worth way more doing something else. If they won't take my autonotes/autonarrative, then I really don't want to spend 5-10 mins writing a narrative for 11 dollars. I don't even want to write a narrative for a 600 dollar crown, lol.

I strongly believe that offices that have patients who are upset at waiting 5 minutes have done it to themselves. I've seen practices coddle their patients to the point where the patient believes they can pull the DYKWIA card. My practice doesn't tolerate that and I find that we get to keep patients who are patient, kind, and understanding and everyone else who gets upset at waiting or complains leaves and brings that attitude to another practice. This is what I've referred to as practice evolution. My practice has evolved to shed ourselves of patients who are not compatible with our office and we shift that burden to other offices who are willing to. Now, there is a downside to that... when the office(s) that have been receiving those incompatible patients closes/shuts down, then I usually get the entitled patients back in my office.

Lately, my experience has been opposite from yours. I find that we're producing more, but I feel like it's been getting easier in the past few months (almost like autopilot).

 

[2TH MVR]

Insurance reimbursements have definitely stagnated, but I think this is where a lot of offices/practitioners fail to adapt.
How do we combat lower insurance reimbursements?
1. We do not have much say in what insurance pays, we can try and renegotiate, but some insurers are so big, they don't need to negotiate.
2. Become more efficient time/procedure-wise or delegate to higher paid in-house specialists if you have enough work to go around (i.e you got enough crowns to keep you busy that you don't need to do endos)
3. Lower overhead

Number 2/3 are the most practical to work on, However, you can only lower your overhead so much until efficiency/quality is affected. Therefore, number 2 is going to be the most important point to work on.

On your PA example, Either I write it off or charge the patient. If the patient is willing to pay for fluoride, they are willing to pay for a PA. Otherwise, if they can't or don't want to pay for the PA, they are probably not going to get treatment, if it's due to financial reasons. Personally, I'm not going to going to grasp at straws writing a narrative for a PA. Time is worth way more doing something else. If they won't take my autonotes/autonarrative, then I really don't want to spend 5-10 mins writing a narrative for 11 dollars. I don't even want to write a narrative for a 600 dollar crown, lol.

I strongly believe that offices that have patients who are upset at waiting 5 minutes have done it to themselves. I've seen practices coddle their patients to the point where the patient believes they can pull the DYKWIA card. My practice doesn't tolerate that and I find that we get to keep patients who are patient, kind, and understanding and everyone else who gets upset at waiting or complains leaves and brings that attitude to another practice. This is what I've referred to as practice evolution. My practice has evolved to shed ourselves of patients who are not compatible with our office and we shift that burden to other offices who are willing to. Now, there is a downside to that... when the office(s) that have been receiving those incompatible patients closes/shuts down, then I usually get the entitled patients back in my office.

Lately, my experience has been opposite from yours. I find that we're producing more, but I feel like it's been getting easier in the past few months (almost like autopilot).

I'm sure I share the same sentiments as the rest of the forum. It is both enjoyable and enlightening to read your posts. You have found a way to be successful where others are just complaining. Efficiency. Choosing the right patients for your practice. What allows you to be in this envious position is the seemingly endless supply of new patients. New patients are the life line of a practice. Plenty of new patients. A practice can thrive regardless of outside pressures: competition, DSOs, insurance hassles, etc. etc. That ... to myself is the key.

I practiced in a saturated city. A new patient just has so many options on where to find treatment. I'm curious. Not sure where you practice, but if you took your practice to the middle of LA, Phx, NY, any urban, saturated city .... would you be as successful?

 

[ToothJockey]

TanMan is a machine. Man produces $3 million+ dentistry as a solo GP in less than 35 hrs/week.

I would never go into dentistry expecting to achieve that.

 

[Cold Front]

TanMan is a machine. Man produces $3 million+ dentistry as a solo GP in less than 35 hrs/week.

I would never go into dentistry expecting to achieve that.

I would be cautious for high producing offices with their insurances triggering an audit. At those production levels, you would stand out, probably in the top 1% range of all offices that bill insurances. Insurances can put extra scrutiny on the claims, specially for 1 doctor offices doing $3M+. Not suggesting 1 doctor can’t produce that level of production, but insurances can look the outliers very closely. Just like the IRS, the audit rate is higher for people making over $500k+ income/yr.

There are few horror stories on dentalTown; where some high producing offices/doctors were asked to pay back a large sum of money ($30-100k) within 30 days, simply because the insurances audited and disagreed with the services the dentist rendered. The insurances can do anything they want.


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[charlestweed]

TanMan is a machine. Man produces $3 million+ dentistry as a solo GP in less than 35 hrs/week.

I would never go into dentistry expecting to achieve that.

Remember he said he worked non-stop and didn't have time to go to the bathroom. Some doctors said they worked 8 hours a day, 5-6 days a week, but they have a lot of downtime in between patients. When some of their patients don't show up, they and their staff just sit around doing nothing. No patient = loss of income because you still have to pay other fixed expenses (rent, staff salaries, electricity etc) to keep your office opened. I don't know how Tanman schedules his patients. But I usually ask my manager to overbook slightly in case some of my patients don't show up. When I work at my own offices, I don't have time to go to the bathroom either. When you are busy, time goes by quickly.

Efficiency is key. If you and your staff have a lot of downtime in between patients, then your office is clearly overstaffed. You either need to book more patients in a day to keep your staff busy or lay off some of them. If there are not enough patients (because you are practicing in an oversaturated area), you need to cut down days......and use those free days in the week to either work for someone else or work at your 2nd office . Inefficiency often leads to poor productivity and lazy staff. I've seen inefficiencies at some of the offices that are listed for sale by older the docs...... overstaffed, unmotivated staff, and nearly empty appointment book.

If you have problem filling your appt book (because you are practicing in an oversaturated area) and you are bored sitting around all day, how about lowering the tx fees and accepting more insurance plans to attract more patients? It's better to have some patients, who pay you below average fees, to work on and to keep the assistants busy than having zero patients and still have to pay the assistants for sitting around doing nothing. Just keep the overhead as low as possible.

 

[sssppp]

Dental hygiene is very saturated.....much worse than dentistry. When I was still in dental school, there were only 3 dental hygiene programs (LLU, USC, and West LA college) in the entire southern California. Now there are at least 8 hygiene programs. Here in CA, most Asian dentists don't hire hygienists because they do their own cleanings. At least being a dentist, one can open an office and has the potiential to become sucessful like you and Tanman. The hygienists can't do that in most states....they have to work under the supervision of the dentists.

Hmmm are you Asian? Or are you racist?

 

[Cold Front]

Hmmm are you Asian? Or are you racist?

The former.


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[Gyuji]

The former.


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It is looking like a ran-off election for Bernie Sanders.

 

[TanMan]

I'm sure I share the same sentiments as the rest of the forum. It is both enjoyable and enlightening to read your posts. You have found a way to be successful where others are just complaining. Efficiency. Choosing the right patients for your practice. What allows you to be in this envious position is the seemingly endless supply of new patients. New patients are the life line of a practice. Plenty of new patients. A practice can thrive regardless of outside pressures: competition, DSOs, insurance hassles, etc. etc. That ... to myself is the key.

I practiced in a saturated city. A new patient just has so many options on where to find treatment. I'm curious. Not sure where you practice, but if you took your practice to the middle of LA, Phx, NY, any urban, saturated city .... would you be as successful?

Subjectively and objectively, I would've said not as successful. Simply because the cost of services performed is higher and the CPP(cost per patient) is higher in a more competitive environment. Depending on the advertising medium and area that you are targeting, the cost per point for television is higher, the CPC is higher, driving up the cost per patient acquired. Essentially, this means that advertising is going to cost you more. Now, there are some horrendously shady ways that you can get cheap advertising and destroy your competition, but I'm not going to outline that here. So, with some "creative advertising and SEO", I think I can get close my CPP in my region v. in a larger area. One thing we forget is that in more saturated cities, there is definitely a higher population. The main thing is to find a reason for people to switch dentists (not just acquire LQ patients) and advertise the hell out of that reason on why they need to leave their loser dentist and get with you (I phrased it that way because I was thinking of valentine's day, dump the zero, go with the hero).

Second, labor cost and regulatory costs. Some states are definitely more expensive to operate, even down the municipal level. If you had to pick a major area, I'd pick a booming suburban area rather than a big city proper. The reason is because the regulations tend to be more lax in the surrounding major area, than the major city itself.

Can I make it? Sure, if I had to. Do I have to? Not really. Would I be as successful? Not as successful, unlikely, but close. Just need to really reign in cost of labor.

I would be cautious for high producing offices with their insurances triggering an audit. At those production levels, you would stand out, probably in the top 1% range of all offices that bill insurances. Insurances can put extra scrutiny on the claims, specially for 1 doctor offices doing $3M+. Not suggesting 1 doctor can’t produce that level of production, but insurances can look the outliers very closely. Just like the IRS, the audit rate is higher for people making over $500k+ income/yr.

There are few horror stories on dentalTown; where some high producing offices/doctors were asked to pay back a large sum of money ($30-100k) within 30 days, simply because the insurances audited and disagreed with the services the dentist rendered. The insurances can do anything they want.

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They can, I've been audited, most of the time no findings, sometimes I send a refund check and just bill the patient, but those are far and few. They will request piles of charts and we have no problem sending them everything they request. Usually for overpayment, 40-50 dollars here and there. I find that most insurances are fair, and I don't make up treatment. There's more than enough legitimate treatment to go around. I believe the key is to always have pre-op photos and radiographs, if ambigious, treatment photos/radiographs, and post-op photos and radiographs. In our claims, we always send all the aforementioned documentation. Especially with emax/LiSi crowns, it's critical to take photos because they look like crap in radiographs. For endos that don't have gross caries, it's important to take an intraoral photo of access w/ rubber dam to show why it failed. A lot of times, it's a fracture into the pulp chamber. It takes 2 seconds to take an intraoral photo and it covers your @ss.

I've dumped insurances that have tried to pull that $hit when it comes to unfair reclamation, RAC audits, or excessive downcoding. Worst offender is United Concordia, medicaid, and some other benefits administrators.

 

[Cold Front]

Subjectively and objectively, I would've said not as successful. Simply because the cost of services performed is higher and the CPP(cost per patient) is higher in a more competitive environment. Depending on the advertising medium and area that you are targeting, the cost per point for television is higher, the CPC is higher, driving up the cost per patient acquired. Essentially, this means that advertising is going to cost you more. Now, there are some horrendously shady ways that you can get cheap advertising and destroy your competition, but I'm not going to outline that here. So, with some "creative advertising and SEO", I think I can get close my CPP in my region v. in a larger area. One thing we forget is that in more saturated cities, there is definitely a higher population. The main thing is to find a reason for people to switch dentists (not just acquire LQ patients) and advertise the hell out of that reason on why they need to leave their loser dentist and get with you (I phrased it that way because I was thinking of valentine's day, dump the zero, go with the hero).

Second, labor cost and regulatory costs. Some states are definitely more expensive to operate, even down the municipal level. If you had to pick a major area, I'd pick a booming suburban area rather than a big city proper. The reason is because the regulations tend to be more lax in the surrounding major area, than the major city itself.

Can I make it? Sure, if I had to. Do I have to? Not really. Would I be as successful? Not as successful, unlikely, but close. Just need to really reign in cost of labor.



They can, I've been audited, most of the time no findings, sometimes I send a refund check and just bill the patient, but those are far and few. They will request piles of charts and we have no problem sending them everything they request. Usually for overpayment, 40-50 dollars here and there. I find that most insurances are fair, and I don't make up treatment. There's more than enough legitimate treatment to go around. I believe the key is to always have pre-op photos and radiographs, if ambigious, treatment photos/radiographs, and post-op photos and radiographs. In our claims, we always send all the aforementioned documentation. Especially with emax/LiSi crowns, it's critical to take photos because they look like crap in radiographs. For endos that don't have gross caries, it's important to take an intraoral photo of access w/ rubber dam to show why it failed. A lot of times, it's a fracture into the pulp chamber. It takes 2 seconds to take an intraoral photo and it covers your @ss.

I've dumped insurances that have tried to pull that $hit when it comes to unfair reclamation, RAC audits, or excessive downcoding. Worst offender is United Concordia, medicaid, and some other benefits administrators.

1. How much time does it take to CYA by taking these extra steps to minimize the audits? To respond to audits? To play cat and mouse with insurances? And the psychological “what if’s” aftermath on each patient you treat - even if you are doing nothing wrong? This is what I meant - when your high billing stands out, you could easily go against the grain with the insurances. The insurance system is built to sniff the high producers a lot, it’s just the way the insurance fraud system is designed.

2. You mentioned medicaid as one of the “worst offenders”. Could you elaborate more? They usually are slow to catch offenders, sometimes even years go by before they audit doctors. When they do, they make sure it’s worth their time and not just an isolated incidents - but a wider abuse. I accept Medicaid through different managed care programs, in a way that limits my exposure to audit because I I’m seeing patients across different Medicaid groups as oppose to one - and they usually compete against themselves and don’t talk to each other about a collective audit or red flags on their providers. I’m actually hoping to drop my state’s Medicaid (one of the better ones in the nation) - it can be a russian roulette for busy offices (like my office) that accepts medicaid. Do you remember the Alaskan hoverboard dentist in the news couple of months ago - who billed Medicaid for IV sedation 100x more than the average dentist in that state? He wouldn’t be caught if it wasn’t for the hoverboard complaint first.


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[TanMan]

1. How much time does it take to CYA by taking these extra steps to minimize the audits? To respond to audits? To play cat and mouse with insurances? And the psychological “what if’s” aftermath on each patient you treat - even if you are doing nothing wrong? This is what I meant - when your high billing stands out, you could easily go against the grain with the insurances. The insurance system is built to sniff the high producers a lot, it’s just the way the insurance fraud system is designed.

2. You mentioned medicaid as one of the “worst offenders”. Could you elaborate more? They usually are slow to catch offenders, sometimes even years go by before they audit doctors. When they do, they make sure it’s worth their time and not just an isolated incidents - but a wider abuse. I accept Medicaid through different managed care programs, in a way that limits my exposure to audit because I I’m seeing patients across different Medicaid groups as oppose to one - and they usually compete against themselves and don’t talk to each other about a collective audit or red flags on their providers. I’m actually hoping to drop my state’s Medicaid (one of the better ones in the nation) - it can be a russian roulette for busy offices (like my office) that accepts medicaid. Do you remember the Alaskan hoverboard dentist in the news couple of months ago - who billed Medicaid for IV sedation 100x more than the average dentist in that state? He wouldn’t be caught if it wasn’t for the hoverboard complaint first.


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1. Not much of my time. Takes a few seconds to take a photo, and most of the time, my staff can take the photos. For post op photos/radiographs, my staff already knows to take them when I leave the room. I have a camera in every room. I have many assistants to cycle through so even if one of them is taking time to do those, I still have 7 other assistants to float around. To respond to audits? Very little to none of my time. Staff will give them all requested info. My notes are there already, I can't change them even if I wanted to, so it is what it is. If it's a non-covered procedure, patient is responsible for office fees.

2. In Texas, we have DQ and MCNA. MCNA is notoriously bad at not paying. If you're talking about rubber stamping payments, then yes, most are slow to catch offenders. I'd rather not play russian roulette with ANY government programs. Every election season, someone needs to be made an example of to appease the public or drum up attention. Even if you did nothing wrong and someone up there decides to set their sights on you, you will be hogtied, especially if you're deemed a flight risk and have the money to defend yourself.

I'm surprised he only made 1.9MM from doing IV sedation for 5 years. Seems like a lot to risk for little gain. Worst part is that he's getting sentenced during election season. My bet is that they'll throw the book at him. I might be wrong, but here, that seems to be the cycle. Put one or two providers on the perp walk every election cycle. A lot of repayment back to the state goes under the radar by settling claims, not publicizing them, and admitting no wrongdoing.

 

[TanMan]

Remember he said he worked non-stop and didn't have time to go to the bathroom. Some doctors said they worked 8 hours a day, 5-6 days a week, but they have a lot of downtime in between patients. When some of their patients don't show up, they and their staff just sit around doing nothing. No patient = loss of income because you still have to pay other fixed expenses (rent, staff salaries, electricity etc) to keep your office opened. I don't know how Tanman schedules his patients. But I usually ask my manager to overbook slightly in case some of my patients don't show up. When I work at my own offices, I don't have time to go to the bathroom either. When you are busy, time goes by quickly.

Efficiency is key. If you and your staff have a lot of downtime in between patients, then your office is clearly overstaffed. You either need to book more patients in a day to keep your staff busy or lay off some of them. If there are not enough patients (because you are practicing in an oversaturated area), you need to cut down days......and use those free days in the week to either work for someone else or work at your 2nd office . Inefficiency often leads to poor productivity and lazy staff. I've seen inefficiencies at some of the offices that are listed for sale by older the docs...... overstaffed, unmotivated staff, and nearly empty appointment book.

If you have problem filling your appt book (because you are practicing in an oversaturated area) and you are bored sitting around all day, how about lowering the tx fees and accepting more insurance plans to attract more patients? It's better to have some patients, who pay you below average fees, to work on and to keep the assistants busy than having zero patients and still have to pay the assistants for sitting around doing nothing. Just keep the overhead as low as possible.

How would you define overbooking? I hear this a lot, but does that mean booking more patients than chairs or booking more than you can handle?

This is how we do our scheduling. I try and book all 13 chairs full, and I don't expect a 100% show rate. Here's an example of today, where 13 chairs were fully booked when we started (no slots left), but note the cancellations on the right side and large holes in the schedule. Still a 20k day, but could've done better if we didn't have so many cancellations. Sorry for the blur, HIPAA and all. I wonder if ortho does the same thing. You're right though, it's better to be busy, because the day goes by so fast.

 

[2TH MVR]

Not to hate on our older population/baby boomers as division is not desired IMO, but I wonder if more gen xers or millennials were in those same positions, there would be a return to status quo, as we lived thru this betrayal from our leaders/gate keepers etc.
Truly tragic.rant over, my bad!

You're new ... so I'll be nice. Baby Boomer here. Again ... with the blame towards the older people in charge. I'll agree that govt probably misled students with all these large loans, and the DS are greedy, but AGAIN for the upteenth time. Young people always like to say they're an ADULT at 18. Then act like one. Be responsible for your own actions. Stop blaming others for your issues. If the environment to be a dentist is not financially doable .... THEN DON'T BE A DENTIST. No one is forcing young people into dentistry. No one. Pick another profession. Even at 18. If someone said to me that for a mere $500,000 before interest .... you could be a dentist earning $120,000 per year ... I would laugh at that person.

 

[yappy]

Not to hate on our older population/baby boomers as division is not desired IMO, but I wonder if more gen xers or millennials were in those same positions, there would be a return to status quo, as we lived thru this betrayal from our leaders/gate keepers etc.

I have no aversion to making money. Who does? However, the way it is made matters even more. If you willingly engage in this racket and feign incompetence or ignorance despite it being the focal point of debate in our field, you should be in debtor's prison. Usury was once one of the greatest sins and punishable offenses, depending on the relationship of creditor-debtor. 18 or 22 y.o (or w.e it is) prospective students are not private equity/ financial powerhouses, solely focused on earning endless capital, yet get destroyed on the interest/daily compounding.

Truly tragic.rant over, my bad!

I appreciate what you're saying. It's why when I was in dental school I treated the faculty and administration with less respect than they expected. As far as I was concerned I was a customer and they were employees delivering a service to me. I think that rubbed most of them the wrong way but the reality is as a student you're paying a high fees for a service. Not unlike buying a mill from Srona and expecting the rep to fulfill their obligations with good service.

Now-a-days dental education is a consumer good where faculty/administration are service workers. This is not like when they went to school where dental schools were ivory tower state institution that were largely subsidized by the public and students were thankful for the opportunity.

What's unfortunate is most faculty and administration go into academics to avoid the customer service dynamic. They're sometimes antagonistic towards students - how do they sleep at night? I don't know all the parties involved that have caused tuition to rise. I think it's damaging to dentistry and I think senior leadership in universities are at least in part to blame. However, it is not really a generational phenomenon. Most baby boomer dentists are not in dental education.

 

[Cold Front]

Hey coldfront, that is really interesting. I still assumed applications are more abundant than ever, as tuition is increasing as if it this parallel universe followed the conventions of supply and demand at a macro level.

Currently, dental school enrollment is at its highest level that it has ever been. The number to watch is the #applicants per available seat in all schools. The lower that number, the easier to get into a dental school. As of 2018-2019 cycle, it stands at 1.8 (applicants per seat). Historically, that number is an all time low. However, schools are hoping that it doesn’t go below 1.0. If it does, then some schools will have difficulty filling seats. Until then, tuition will increase - and even though going from 1.8 to 1.0 applicants per seat seems a small margin, the total # applicants has to drop by almost 50% for schools to start worrying about filling their classes, and that could easily take another 10-20 years at the minimum to see such drop, which is bad news for all future pre-dents. The DS debt will continue to rise in the meantime.


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[Cold Front]

1. Not much of my time. Takes a few seconds to take a photo, and most of the time, my staff can take the photos. For post op photos/radiographs, my staff already knows to take them when I leave the room. I have a camera in every room. I have many assistants to cycle through so even if one of them is taking time to do those, I still have 7 other assistants to float around. To respond to audits? Very little to none of my time. Staff will give them all requested info. My notes are there already, I can't change them even if I wanted to, so it is what it is. If it's a non-covered procedure, patient is responsible for office fees.

2. In Texas, we have DQ and MCNA. MCNA is notoriously bad at not paying. If you're talking about rubber stamping payments, then yes, most are slow to catch offenders. I'd rather not play russian roulette with ANY government programs. Every election season, someone needs to be made an example of to appease the public or drum up attention. Even if you did nothing wrong and someone up there decides to set their sights on you, you will be hogtied, especially if you're deemed a flight risk and have the money to defend yourself.

I'm surprised he only made 1.9MM from doing IV sedation for 5 years. Seems like a lot to risk for little gain. Worst part is that he's getting sentenced during election season. My bet is that they'll throw the book at him. I might be wrong, but here, that seems to be the cycle. Put one or two providers on the perp walk every election cycle. A lot of repayment back to the state goes under the radar by settling claims, not publicizing them, and admitting no wrongdoing.

Schools can get audited for unusual high production numbers as well. Medicaid is currently investigating billing irregularities at UNLV dental school going back 4 years. Like I said before, high producing dentist is just like being a high earner in income under the IRS. You just have to accept the audits and the headaches that come with it, whether a dentist/their staff spend the time to respond to subpoenas and requests from audits or hire an attorney to deal with it, it’s all part of being an outlier in the standard deviations. I personally choose to limit how much I want produce; 1) I’m not going to work myself beyond the limits of my body, 2) I won’t be happier if I make that extra income as a dentist, unless it was a passive income, 3) I don’t want to be audited and the risks that comes with it.

Billing irregularities plague UNLV dental school

New data raises questions about overbilling and double billing of patients and insurance by UNLV dental school.

www.reviewjournal.com

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[deleted903013]

Currently, dental school enrollment is at its highest level that it has ever been. The number to watch is the #applicants per available seat in all schools. The lower that number, the easier to get into a dental school. As of 2018-2019 cycle, it stands at 1.8 (applicants per seat). Historically, that number is an all time low. However, schools are hoping that it doesn’t go below 1.0. If it does, then some schools will have difficulty filling seats. Until then, tuition will increase - and even though going from 1.8 to 1.0 applicants per seat seems a small margin, the total # applicants has to drop by almost 50% for schools to start worrying about filling their classes, and that could easily take another 10-20 years at the minimum to see such drop, which is bad news for all future pre-dents. The DS debt will continue to rise in the meantime.


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Do you think a school like NYU will have trouble filling their seats soon? They're total cost is getting close to the one million mark.

 

[ToothJockey]

NYU still receives 3000+ applicants for 300+ seats last time I checked. Even if applicant numbers drop, all NYU has to do is lower admission standards and they can easily fill their seats.

Bad news for naive students who think they can pay off $1 mil debt on a dentists salary comfortably. Good news for NYU because naive students aren’t exactly in short supply.


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[AONLINE]

I appreciate what you're saying. It's why when I was in dental school I treated the faculty and administration with less respect than they expected. As far as I was concerned I was a customer and they were employees delivering a service to me. I think that rubbed most of them the wrong way but the reality is as a student you're paying a high fees for a service. Not unlike buying a mill from Srona and expecting the rep to fulfill their obligations with good service.

Now-a-days dental education is a consumer good where faculty/administration are service workers. This is not like when they went to school where dental schools were ivory tower state institution that were largely subsidized by the public and students were thankful for the opportunity.

What's unfortunate is most faculty and administration go into academics to avoid the customer service dynamic. They're sometimes antagonistic towards students - how do they sleep at night? I don't know all the parties involved that have caused tuition to rise. I think it's damaging to dentistry and I think senior leadership in universities are at least in part to blame. However, it is not really a generational phenomenon. Most baby boomer dentists are not in dental education.

At my school faculty are pretty good at advocating for students. The people who tend to give us most hard times are the lab technicians and other employees such as dental assistants. I don’t understand why they think they’re entitled to treat us like s**t. A faculty recently told me that I pay a lot of money to be in school so I should not be mistreated by anyone. I’m very grateful to work with faculty like her.

 

[JustAWanderingStudent]

Currently, dental school enrollment is at its highest level that it has ever been. The number to watch is the #applicants per available seat in all schools. The lower that number, the easier to get into a dental school. As of 2018-2019 cycle, it stands at 1.8 (applicants per seat). Historically, that number is an all time low. However, schools are hoping that it doesn’t go below 1.0. If it does, then some schools will have difficulty filling seats. Until then, tuition will increase - and even though going from 1.8 to 1.0 applicants per seat seems a small margin, the total # applicants has to drop by almost 50% for schools to start worrying about filling their classes, and that could easily take another 10-20 years at the minimum to see such drop, which is bad news for all future pre-dents. The DS debt will continue to rise in the meantime.


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I actually feel like 20 years from now the full effect of the debt increase will be felt throughout the entire system. With articles coming out about how dentistry is the most expensive profession, and (personally) knowing people who did medicine because the risk of return is much better, I see dentistry going through the same issues of the 80s: where schools had to close down due to the decrease of applicants... and back then it wasn't even because of the debt.

The debt itself is already pushing people away from the profession to one that is just as rewarding and has a much better return, and that is medicine. This is considering that medicine has nearly 2x more schools than dentistry, with now new schools being created by the health insurance themselves...

Something must be done about the profession, and fast if they want to save it.

 

[ToothJockey]

You're new ... so I'll be nice. Baby Boomer here. Again ... with the blame towards the older people in charge. I'll agree that govt probably misled students with all these large loans, and the DS are greedy, but AGAIN for the upteenth time. Young people always like to say they're an ADULT at 18. Then act like one. Be responsible for your own actions. Stop blaming others for your issues. If the environment to be a dentist is not financially doable .... THEN DON'T BE A DENTIST. No one is forcing young people into dentistry. No one. Pick another profession. Even at 18. If someone said to me that for a mere $500,000 before interest .... you could be a dentist earning $120,000 per year ... I would laugh at that person.

I agree with some of what you're saying. We are responsible for our actions.

However, I feel like you are shifitng focus from the real issues. Do you really think that dentistry should be guarded by a high cost barrier? I think it's pretty absurd that some kids cannot become dentists because the costs are too high. The real problem is not that a bunch of naive teens are signing up for expensive dental schools. The real problem here is that these expensive dental schools exist in the first place.

 

[anonymousdent]

Do you think a school like NYU will have trouble filling their seats soon? They're total cost is getting close to the one million mark.

- have trouble, yes. I'd be surprised if they don't already "have trouble" as any student with more than one offer would be dumb to choose the more expensive option aside from some very unique circumstances (of course there are exceptions to the rule). will seats go unfilled, no. I'd bet schools that start to have an issue will accept more international students. who knows what will really happen. I feel like whatever it is the story doesn't end well for "the average dentist" and some patients.

The real problem here is that these expensive dental schools exist in the first place.

I don't disagree but what exactly are we (read as: dental students, dentists) supposed to do about it? seems like capitalism at it's finest. The only solution I see is hounding our politicians about how we do not have an access to care problem and how new schools and more dentists deep in debt ironically hurts the profession and thus the oral health of the average patient. good luck convincing a politician of that statement they'll just think you're worried about yourself and your own turf (true, we are).

but seriously what are we supposed to do? I feel like being a part of organized dentistry at the local and state level is at least an attempt to try and combat it. Oh and I don't feel bad for any dentist in extreme debt. you live in the greatest country in the world where you have the opportunity to do anything you want as long as it doesn't break state or federal laws and you chose to take money with the expectation that it would better your lifestyle and you would pay it back. Sorry if it did not work out that way but you made a decision and let it be a very expensive lesson in financial literacy. IF you want to blame someone about your situation I suggest walking into the bathroom and looking into the mirror.

 

[yappy]

Providing students with public debt is NOT capitalism. If public loans to students disappeared the higher ed bubble would pop and student loans would carry risk, for both parties, and the principal amount would be dictated by risk and the value of the product being financed.

I don't disagree but what exactly are we (read as: dental students, dentists) supposed to do about it? seems like capitalism at it's finest. The only solution I see is hounding our politicians about how we do not have an access to care problem and how new schools and more dentists deep in debt ironically hurts the profession and thus the oral health of the average patient. good luck convincing a politician of that statement they'll just think you're worried about yourself and your own turf (true, we are).

 

[Cold Front]

I actually feel like 20 years from now the full effect of the debt increase will be felt throughout the entire system. With articles coming out about how dentistry is the most expensive profession, and (personally) knowing people who did medicine because the risk of return is much better, I see dentistry going through the same issues of the 80s: where schools had to close down due to the decrease of applicants... and back then it wasn't even because of the debt.

The debt itself is already pushing people away from the profession to one that is just as rewarding and has a much better return, and that is medicine. This is considering that medicine has nearly 2x more schools than dentistry, with now new schools being created by the health insurance themselves...

Something must be done about the profession, and fast if they want to save it.

I think pre-dents who want to specialize will be hurt with student loans debt the most.

The process is typically 6-7 years from D1 in DS to finishing perio, Endo, pros or ortho residency. Each of those 7 years come with a 3-5% increases in tuition and cost with compounding interest. Each of those years is about $100k before interest, today. Even if they have wealthy parents (not sure why wealthy parents would pay that high for DS), that’s a 7 years of life that leads to declining insurance reimbursements and the real possibility of becoming a pawn for the DSO industry. The new grads who work for DSO’s goes up every year.

These are all projections and obviously time will tell, but there is a strong and clear evidence there that the profession has already shot itself on the foot.


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[TanMan]

I agree with some of what you're saying. We are responsible for our actions.

However, I feel like you are shifitng focus from the real issues. Do you really think that dentistry should be guarded by a high cost barrier? I think it's pretty absurd that some kids cannot become dentists because the costs are too high. The real problem is not that a bunch of naive teens are signing up for expensive dental schools. The real problem here is that these expensive dental schools exist in the first place.

I would disagree in that I think there's more than one source of the problem. There's the freely available money for students to sign up for, ever increasing tuitions due to market demands (people wanting to become dentists), and students willing to sign up their life and credit away because they didn't think their decisions through. If something broke in the cycle (whether the money dries up or market demand dries up due to tuition going up too high, or students actually start thinking about whether the tuition investment is worth it), then this problem would not exist. However, as long as there's freely available money or demand for dental school seats, schools can charge whatever they want. Now, as a taxpayer, I'm against freely available money that comes from the taxpayer. However, I would still be in support of private loans/lenders supplying the money because it will ensure that students still have the opportunity to become a dentist if they choose to.

Dentistry is not guarded, by intention, by a high cost barrier. The high cost barrier is there because the market allows for it. Now, if students started thinking with their heads about dentistry, its costs, and ROI, then some may think twice before applying to dental school. As people have said, I am an outlier, but I am willing to work hard to make things work. I am starting to see more and more that dentists are, for the most part, just lazy. If they are only willing to see 1-2 patients an hour, want 1-2 hour lunch breaks, half day fridays and bank hours, then they deserve to be broke. Being a dentist does not make us special, it is what we can offer our patients to want our services.

At my school faculty are pretty good at advocating for students. The people who tend to give us most hard times are the lab technicians and other employees such as dental assistants. I don’t understand why they think they’re entitled to treat us like s**t. A faculty recently told me that I pay a lot of money to be in school so I should not be mistreated by anyone. I’m very grateful to work with faculty like her.

Treat the administration/full time faculty like the police. Don't talk to the police. I find that the support staff are more level headed than the administration/full time faculty. Sure, they might be aholes because they think these students will belittle them when they get their DDS/DMD. A gift and flattery goes a long way with the support staff in dental school. Take them out to KBBQ, a round of beers/shots(or 10), and it'll make your life so much easier. If you respect them, they will warm up and become your best friend/advocate in dental school. Need an appointment? No problem! Need some extra supplies or favors in lab work, done! It won't work on everyone, but works for most people.

 

[charlestweed]

How would you define overbooking? I hear this a lot, but does that mean booking more patients than chairs or booking more than you can handle?

This is how we do our scheduling. I try and book all 13 chairs full, and I don't expect a 100% show rate. Here's an example of today, where 13 chairs were fully booked when we started (no slots left), but note the cancellations on the right side and large holes in the schedule. Still a 20k day, but could've done better if we didn't have so many cancellations. Sorry for the blur, HIPAA and all. I wonder if ortho does the same thing. You're right though, it's better to be busy, because the day goes by so fast.

View attachment 295127

I think it’s both....more patients than the available chairs and more patients than I can handle. On the handwritten appointment book, we give each patient a 15-minute slot, regardless of what procedure the patients need. Because it’s handwritten, we can always “squeeze” in more patients. If my manager feels we are way overbooked, she notifies me a couple of days in advance so I have enough time to ask 1 additional P/T assistant to come help. A simple wire change procedure only takes 5 minutes (doctor’s time is less than a minute). But a full mouth bracket bonding procedure takes my assistants 30-45 minutes to perform (the doctor’s time is only 3-5 minutes). A lot of time we had unexpected starts (for example, a mom brought in a patient’s younger sibling for consultation without an appointment and mom wanted to start the treatment the same day) and they may slow us down a little bit. When I run out of chairs, I use the record/xray room to do quick procedures like retainer delivery, retainer check, oral hygiene instructions for new patients etc. When we have 2-3 patients, who are siblings or husband and wife or mom and son/daughter, we put all of them in the same treatment room to save chairs.

 

[charlestweed]

How about spending the next 3 years living like a medical resident? After graduation from med school, a medical resident gets paid around $50k/year. After graduation, a dentist makes between $120-150k/year (depending on how hard one is willing to work). If a dentist lives on a budget of $50k/year like a med resident and uses the other $50-80k portion of the salary to pay off the smaller student loan amounts first (using debt snowball method), he/she should be able bring the original $500k student debt amount down to less than $300k in 3 years. This newly reduced $300k debt amount should be equivalent to the debt amount that many med students (or the dentist who graduated around the same time with ColdFront) owe after graduation.

I know it’s easier said than done because I graduated a long time ago and didn’t have that much debt. I know it’s hard to resist the temptation to buy cool things after you spend 8 years (4 year undergrad + 4 year dental school) of your life living in poverty. I couldn’t resist and I bought a house 3 months after graduation. But this, unfortunately, may be the only way for the current students, who want to become a dentist, to deal with their future debt.

 

[charlestweed]

.......not sure why wealthy parents would pay that high for DS.....

Most parents want their kids have a successful career and be able to take care of themselves in the long run. The parents can’t live forever to provide financial support. For me, personally, the hard part is not the tuition money because I can afford to pay for my kids’ educations…yes, at any price. The hard part is my kids’ willingness to go to a professional school….willingness to work hard for a bright future. A few of my dentist friends want their kids to follow their footstep but their kids don’t want to. Their kids used their money to travel everywhere while in college and they messed up their undergrad GPA’s badly. Some of their kids are in the mid 20s….have no degree, no plan for the future. I pray that my kids won’t end up like those kids.....and I can only pray.

When you have kids, you'll know what I am talking about.

 

[P7898]

My brother is a radiologist in $500k of debt and I will be a dentist with $150k of debt. I think it is all relative really. You have to choose what interests you and know your financial limitations. Radiologists start around $300k after residency. My spouse started at $160k after AEGD. He has to work 50 hours a week. She has to work 38 hours a week. This is reality. We all have to work hard. But it just depends on what actually makes fiscal sense though. We can debate all we want but really comparing apples to oranges. Dentists owners make $$ too but that involves more debt. So on top of the $150k then put on $400k more and be at ($275-$300k income) and then we are even with radiology starting out. But their salaries increase too after experiences. He has to worry about misdiagnosing an image and possibly killing someone in the process. My spouse is worried about sub margination on composite and making sure all the canals in the RTC tooth don't have voids. Soo you have to do what makes sense. It didn't make sense for my brother to be a family physician at ~$200k with $500k debt starting. It doesn't make sense for me to get into $400k debt to start out at ~$150k it just doesn't make sense. This is why I think dentistry is work it at $250k and under in debt. It allows you space to take on more debt for your own practice and really take advantage off what our profession is all about.

 

[Cold Front]

Most parents want their kids have a successful career and be able to take care of themselves in the long run. The parents can’t live forever to provide financial support. For me, personally, the hard part is not the tuition money because I can afford to pay for my kids’ educations…yes, at any price. The hard part is my kids’ willingness to go to a professional school….willingness to work hard for a bright future. A few of my dentist friends want their kids to follow their footstep but their kids don’t want to. Their kids used their money to travel everywhere while in college and they messed up their undergrad GPA’s badly. Some of their kids are in the mid 20s….have no degree, no plan for the future. I pray that my kids won’t end up like those kids.....and I can only pray.

When you have kids, you'll know what I am talking about.

I agree Charles.

Part of the problem is the naivety of the parents to think their kids will do exactly as they planned for them. I personally don’t think like that. Kids should have some level of freedom to whatever their talent and ambition guides them to, or they will forever resent the parents for pushing them to do something the kids don’t enjoy doing. Look at some of the residents and predents in these forums who complain and talk about how much they hate school, but they are only doing it to satisfy or not let someone else down. That’s really absurd!

If I had $1M and my (future) kid wanted to go to dental school and specialize, and that kid really wanted to be an endodontist, periodontist or orthodontist so bad... yes, I will spend that $1M to help them pay for school. It’s another, when I’m telling the kid that he/she must listen to me and I will pay the $1M to get them there and become a specialist at all cost - under my direct orders. That’s just rolling the dice, and we don’t even know what dentistry could look like in 10-20 years from now... all that pushing on a kid for a field that still has a big “?” in it’s future.

Have you considered anything else other than dentistry for your kid? Or “it has to be” dentistry or medicine?


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[charlestweed]

I agree Charles.

Part of the problem is the naivety of the parents to think their kids will do exactly as they planned for them. I personally don’t think like that. Kids should have some level of freedom to whatever their talent and ambition guides them to, or they will forever resent the parents for pushing them to do something the kids don’t enjoy doing. Look at some of the residents and predents in these forums who complain and talk about how much they hate school, but they are only doing it to satisfy or not let someone else down. That’s really absurd!

If I had $1M and my (future) kid wanted to go to dental school and specialize, and that kid really wanted to be an endodontist, periodontist or orthodontist so bad... yes, I will spend that $1M to help them pay for school. It’s another, when I’m telling the kid that he/she must listen to me and I will pay the $1M to get them there and become a specialist at all cost - under my direct orders. That’s just rolling the dice, and we don’t even know what dentistry could look like in 10-20 years from now... all that pushing on a kid for a field that still has a big “?” in it’s future.

Have you considered anything else other than dentistry for your kid? Or “it has to be” dentistry or medicine?


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Nobody likes school. Nobody likes to work. I don't. I've seen countless number of adults (my assistants, my handyman, my patients' parents etc), who regretted the decision for not going to college. They wished they could turn back the clock to undo all the mistakes they made when they were young. I've seen a lot of college graduates who picked a wrong major and ended up getting jobs that are totally unrelated to what they studied in school...and struggle to pay back a huge amount of student loans. I've seen engineers and people with highly paid jobs quit their jobs to go back to dental/med school because they wanted higher income and job stability....purely a financial reason for them.

Who doesn't want to have a job that he/she loves and allows him/her to make a lot of money at the same time? Who doesn't want to live like a boss but doesn't have to work hard to earn that lifestyle?

Whether you like dentistry or medicine or not, at least these 2 fields are a safe career choice. You can be an introvert, you don't need to have great people skills, you speak Ok English with an accent (like me), you have zero leadership skill, you don't have to be in good physical shape (required for being sport player, a fireman, or a police officer)......despite all these shortcomings, you are still guaranteed to have a 6-figure income when you are a dentist or doctor. If you hate dentistry so much....fine, just work 2 days/week and you still make $60-70K/year, which is a lot more money than doing something that you love but having to work for 8 hours/day, 5 days/week.

Edit: My referral GP, who is currently in her mid 50s, was very proud of her daughter for choosing to become dentist like her. The daugher was a straight A student in HS and received a full 4-year scholarship at her local university. But then after the first year in college, the daughter decided to study abroad, in Korea....and then she traveled to Japan with friends. And now 7 years later, the daughter finally finished her BS degree but still has no plan on for her future. I didn't dare to ask this referring GP about her daughter anymore because when I asked about her daughter, she cried. This GP is a breast cancer survivor. Her husband, who is a former engineer, helps her with the lab work because he got laid off by Boeing and couldn't find a another job. In her mid 50s, she still has to work hard to support her kids. The good thing is her practice is doing very well. Hopefully, her younger son, who is still in HS, will make her happy.

 

[P7898]

Also like medical residency takes 4-5 years (high paying specialties). A general dentist can do an AEGD, work for a year, and butch an office at year 3 so make good money quicker and investment more sooner.

 

[2TH MVR]

Edit: My referral GP, who is currently in her mid 50s, was very proud of her daughter for choosing to become dentist like her. The daugher was a straight A student in HS and received a full 4-year scholarship at her local university. But then after the first year in college, the daughter decided to study abroad, in Korea....and then she traveled to Japan with friends. And now 7 years later, the daughter finally finished her BS degree but still has no plan on for her future. I didn't dare to ask this referring GP about her daughter anymore because when I asked about her daughter, she cried. Hopefully, her younger son, who is still in HS, will make her happy.

Funny. This sounds just like my two children. Same scenario. Raised my children to follow in my foot steps. Unfortunately ... the 1st child did not want to go into dentistry or medicine. The 2nd child is interested in medicine. I used to beat myself up over the 1st child. Blaming myself for her not having more will to go into a professional field. Not anymore. You can only do so much. We provided all the necessary tools and $$ for the 1st child to succeed. You can only do so much. But guess what? The 1st child is doing fine. Engaged to marry her HS sweetheart. He has a good finance job (NO school debt). She continues to work on her business degree. All is good.
Children will find their own path. The best that parents can do is to eliminate any roadblocks to their success. But in the end ...it's up to them. Besides. My wife and I are in our late 50's. It's OUR time to enjoy the fruits of our hard work. Our time to reconnect as a couple. Can't wait to go to Greece this summer.

 

[charlestweed]

Funny. This sounds just like my two children. Same scenario. Raised my children to follow in my foot steps. Unfortunately ... the 1st child did not want to go into dentistry or medicine. The 2nd child is interested in medicine. I used to beat myself up over the 1st child. Blaming myself for her not having more will to go into a professional field. Not anymore. You can only do so much. We provided all the necessary tools and $$ for the 1st child to succeed. You can only do so much. But guess what? The 1st child is doing fine. Engaged to marry her HS sweetheart. He has a good finance job (NO school debt). She continues to work on her business degree. All is good.
Children will find their own path. The best that parents can do is to eliminate any roadblocks to their success. But in the end ...it's up to them. Besides. My wife and I are in our late 50's. It's OUR time to enjoy the fruits of our hard work. Our time to reconnect as a couple. Can't wait to go to Greece this summer.

As parents, we always want our children to at least have the same comfortable lifestyle (or better) that we have now: good stable high income job, no worry about getting laid off, financial independence, prestigious profession, respect from friends and neighbors, nice cars, a nice house in an affluent zip code, expensive vacation trips, etc. We don't want our children to lose all of these conveniences (because of their poor career choice) after we die. We want them to be better than us. In 2-3 years, our kids will become 18 yo adults......we can't force them....we can only pray.

 

[AONLINE]

My brother is a radiologist in $500k of debt and I will be a dentist with $150k of debt. I think it is all relative really. You have to choose what interests you and know your financial limitations. Radiologists start around $300k after residency. My spouse started at $160k after AEGD. He has to work 50 hours a week. She has to work 38 hours a week. This is reality. We all have to work hard. But it just depends on what actually makes fiscal sense though. We can debate all we want but really comparing apples to oranges. Dentists owners make $$ too but that involves more debt. So on top of the $150k then put on $400k more and be at ($275-$300k income) and then we are even with radiology starting out. But their salaries increase too after experiences. He has to worry about misdiagnosing an image and possibly killing someone in the process. My spouse is worried about sub margination on composite and making sure all the canals in the RTC tooth don't have voids. Soo you have to do what makes sense. It didn't make sense for my brother to be a family physician at ~$200k with $500k debt starting. It doesn't make sense for me to get into $400k debt to start out at ~$150k it just doesn't make sense. This is why I think dentistry is work it at $250k and under in debt. It allows you space to take on more debt for your own practice and really take advantage off what our profession is all about.

With such a small amount of debt (compared to the average cost of dental education), are you planning to specialize afterwards?

 

[P7898]

With such a small amount of debt (compared to the average cost of dental education), are you planning to specialize afterwards?

I am on the "cusp" - no pun intended. I have thought about it but honestly GP practice owner is really the way to go. I mean you pick and choose cases. And I want to be my own boss too and not have to worry about working for someone for too long ( I will associate for a year ). But the thing is my spouse is in no debt either and is a GP. So we have that leeway to spend $$$ on an existing office. But really when you specialize (unless you like it) you are giving up income - a lot of income if you want to be a GP owner. Your practice that you have becomes an asset that you can liquidate when you practice - GP practices are easier to sell and hold more value than specialty practice. You make more income on average with your own office too. So really if you decide to do I don't know peds or ortho right. Peds I think is the best gig out there if you like children but the issue is that it is hard to find a good specialty practice to buy. I know start up peds and ortho offices you don't need to shmooz GPs for refferals as much but I honestly want to spend my free time with my spouse and family instead of taking people out to dinner because I want patients. Yes my spouse is in no debt and GP in late 20s and I will be right at 30 if I did an AEGD and in about $150k of school debt. I am still worried with paying this because a six figure debt is a lot if you plan on having children, buying a house, new cars, etc. But each person has their own forte. I like a variety and (knock on wood) a quick learner so I do plan on offering all services except of traditional braces because you can get in a lot of trouble if you do those wrong - best to refer that. But I enjoy endo, crowns, haven't done implants yet bet taken CE so that pretty much says it all.

If you think specializing is a better path to money I would agree in terms of if you are comparing an associate GP to an associate specialist. But it is a whole other ball game when you are a GP owner vs specialty owner - you have no limits than yourself. But like I said. I would be bored doing the same thing over again everyday. Yes it would probably be nice in my 50s doing predicable things everyday but as I get older and lazier I can just refer so not a big deal. Do what you love and you'll never work a day in your life. If you are chasing money GP owner. If you want a good work life balance still GP owner. But if you love a certain aspect of dentistry and fine doing nothing else - specialize. Don't let your debt or numbers determine that - ever.

 

[Rube]

Hate to say this, because I like dentistry, but if I were starting school now I wouldn't do it. I feel like... and I know I sound like generations before me, but I feel like we're the last generation who will do somewhere between ok and good.

There is a single reason: PPO insurance is everywhere and reimbursements to dentists are dropping to medicaid levels. Just this month Delta cut reimbursements again. This is not the 90s or even early 2000s anymore. The old guys would say the 80s were the days, we'd say we wish it were the 90s.

 

[2TH MVR]

20 years ago .... specialty practices made more than GP practices. It wasn't even close.
Today. Yes ... the dynamics have changed.

Hate to say this, because I like dentistry, but if I were starting school now I wouldn't do it. I feel like... and I know I sound like generations before me, but I feel like we're the last generation who will do somewhere between ok and good.

There is a single reason: PPO insurance is everywhere and reimbursements to dentists are dropping to medicaid levels. Just this month Delta cut reimbursements again. This is not the 90s or even early 2000s anymore. The old guys would say the 80s were the days, we'd say we wish it were the 90s.

Agreed. The 90's were awesome.

 

[TanMan]

Schools can get audited for unusual high production numbers as well. Medicaid is currently investigating billing irregularities at UNLV dental school going back 4 years. Like I said before, high producing dentist is just like being a high earner in income under the IRS. You just have to accept the audits and the headaches that come with it, whether a dentist/their staff spend the time to respond to subpoenas and requests from audits or hire an attorney to deal with it, it’s all part of being an outlier in the standard deviations. I personally choose to limit how much I want produce; 1) I’m not going to work myself beyond the limits of my body, 2) I won’t be happier if I make that extra income as a dentist, unless it was a passive income, 3) I don’t want to be audited and the risks that comes with it.

Billing irregularities plague UNLV dental school

New data raises questions about overbilling and double billing of patients and insurance by UNLV dental school.

www.reviewjournal.com

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It's not just about how much you produce, but also your procedure mix/ratio. Insurances have ratios that you have to be within not to get audited (crown:fills ratio, crown:endo ratio, etc...).

Hate to say this, because I like dentistry, but if I were starting school now I wouldn't do it. I feel like... and I know I sound like generations before me, but I feel like we're the last generation who will do somewhere between ok and good.

There is a single reason: PPO insurance is everywhere and reimbursements to dentists are dropping to medicaid levels. Just this month Delta cut reimbursements again. This is not the 90s or even early 2000s anymore. The old guys would say the 80s were the days, we'd say we wish it were the 90s.

I've always pushed this among new grads - produce or perish. The way we combat lower reimbursements is to go faster and be more efficient. Things are getting worse and there should eventually be a point where reimbursements will hit a floor. I think my lowest molar endo right now sits around 650, which is not a problem because it can be done in 14-18 minutes (with a buildup, that adds 150-200+). Those that will suffer are those that take 1-2 hours for a molar endo and/or multiple appointments.