my general dentist does everything from endo to oral surgery and never refers her patients to any specialists. the only downside is that she has to file a claim for the specialty precedure to the insurance company beforehand and have it approved to make sure she can get paid for the treatment she'll give to her patients. She owns five chairs in a single 500 sq ft room and hires her cousin(with no formal detnal hygiene training) to do dental hygiene work. She also does root canal for $450 cash payment to those with no insurance. her net income is over 300K year. In contrast, a friend of mine is an endo who went to columbia for undergraduate and harvard for dental school now end up working for a dental office and her salary is 180K before tax. He thinks he's stuck because an endo has no direct access to the patient pool and make a living on referrals from general dentists. He said that if he could do it all over again, he would just go to a state school for cheap tuition and start his own practice right after he gets his DDS.