Is it worth it to pursue dentistry nowadays?

[endoaccess]

Dentistry can be very stressful in a different way. Anyone coming into this expecting stress free is in for a rude awakening. You are making a living doing something that people are afraid of, don’t like, and don’t want to spend money on. Your patients are not sedated. You have to act fake happy all day. You run a business with staff that are living by paycheck. You have no peers on a daily basis. You have patients threatening you with bad reviews. You’ll have colleagues that are scam artists. The whole profession just has a cloud over it in general. It wears on you.

Is it worth it? For some yes, for some no. I’m 6 years out, and it stopped being fun about 4 years ago. I really enjoyed it in school and the beginning. After dealing with some real jerks it became less fun. Ive turned into a colder person dealing with these people on a daily basis. It’s just not a great atmosphere long term. The highs are very muted.

I think it’s a good profession if you are naturally outgoing, and small town type of person. If you are introverted it will wear you down. If you live in a city it’s a grind. If you are an associate long term, forget it.

One thing you start to realize as you cross paths with other people, there are many ways to make a living. You don’t have to be doctor/lawyer. We have zero benefits and no pension. There is no windfalls. It is hard to scale. You just grind it out until retirement.

For 500k I would say you have to have a very specific plan. If you are just looking for a job, forget it. $600/day associate job ain’t gonna cut it. This level of debt requires motivated ownership. And you will drop another 500k-1mil to buy a decent practice.

Some guys will kill it no doubt. A small number. Guys like tanman are extreme outliers. I have a friend like this, it’s not realistic to think everyone can do it. It’s a certain personality type.

Really though, it doesn’t matter what we say. You will rationalize your way into the profession, I know, I was there once. Just make sure you have some good hobbies for your free time.

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[setdoc7]

TM, your posts are interesting, but there are several important things missing. I'm all for chairs and counters and nomads and cheap lites, but what about instruments and supplies? Equipping 6 ops is not cheap, and will up the stakes over 100k. even starting out equipping 3-4 of the ops is not cheap. No mention of lab work, and using a deeply discounted lab can be the kiss of death to any practice with higher aspirations, as the quality coming out of them is generally not good. Cheap lab work breaks, forcing constant remakes, which you may not be able to bill for if you wish to retain your patients.
In any case, this formula will not work in all markets (NYC), and you have not mentioned any compliance topics, which also cost money.

 

[TanMan]

TM, your posts are interesting, but there are several important things missing. I'm all for chairs and counters and nomads and cheap lites, but what about instruments and supplies? Equipping 6 ops is not cheap, and will up the stakes over 100k. even starting out equipping 3-4 of the ops is not cheap. No mention of lab work, and using a deeply discounted lab can be the kiss of death to any practice with higher aspirations, as the quality coming out of them is generally not good. Cheap lab work breaks, forcing constant remakes, which you may not be able to bill for if you wish to retain your patients.
In any case, this formula will not work in all markets (NYC), and you have not mentioned any compliance topics, which also cost money.

- For instruments: Go buy instruments made from Pakistan to begin with. They suck, but it's better than nothing. When you have more money, go buy some hu-friedy's or other name brand items. The whole key is start cheap, upgrade later.
- Endo motors, apex locators, just buy one for now, used if possible, move it from room to room until you can afford more.
- For supplies: Personally, I like safco. They typically have the lowest prices and the best sales. You can do net32 for certain items, but the shipping times vary a lot. When you first start out, you do not need a massive inventory of items, just enough to make sure you can get through a few days (1 week). You don't need name brand items for now, unless there's a sale or coupon.
- Labwork mostly follows garbage in, garbage out type of principle when it comes to fixed work. I use glidewell for a lot of labwork, and I like them a lot. Fast and efficient; although sometimes, I suspect they get a batch of new tech grads and you get bad work. You do not need a large fancy inhouse lab. As a general dentist, you should not be doing much, if any of the lab work, in your office. Your time is worth more than that. You can easily go to harbor freight and get a lathe if you want to polish dentures or a used dry model trimmer from labs that close down. Labwork is typically on a net 30 invoicing and payment. That gives you some leeway into billing out the crown and receiving payment before you have to pay the lab bill.
- One thing I did once we started reaching 80-100 was to finance a cerec. Best investment ever, if the crown breaks, you can replace very easily with minimal downtime. If the margins were good, you can always just remill/bake ahead of time before the patient even gets there, quick 15 min changeout.

Compliance depends on the state. You need to decide whether to follow recommendations (which are usually more over the top), or do the bare minimum that the state requires you to do.
Examples of things to remain compliant (This is not an all-inclusive list):
Spore testing for autoclaves: In-Office Biological Monitoring | Crosstex Biological Monitoring Service Provider
Amalgam separator for wastewater: State or municipalities will determine the need: Hg5 Amalgam Separation Series | Hg5 Amalgam Separator. Easy to plumb in, if your state/city doesn't need it, don't bother with it.
OSHA/Infection control/HIPAA training: outsourced or if available, just get a dvd and have your staff watch it and either take a quiz or sign off that they understand and went through training
Radiation exposure: Need to determine if your state requires badges. Use common sense... if your staff member is pregnant, don't have them take any radiographs.
Clean water: Either have a closed bottle system with water source from gallon jugs, use sterisil straw system, or have an RODI/UV system...
Quick turnover of rooms, use barriers and cavicide one (1 min only - very harsh on plastics though)

Edit: PPE - this one is kindof a no brainer, know the minimum requirements of your state, BUT if your staff requests any kind of specific PPE that is not required or mandated, provide it anyway. Reduces your liability.

There's companies out there you can hire to outsource your administrative compliance duties (such as Unemployment, HR related stuff, etc...)

 

[dentistspec123]

Dentistry can be very stressful in a different way. Anyone coming into this expecting stress free is in for a rude awakening. You are making a living doing something that people are afraid of, don’t like, and don’t want to spend money on. Your patients are not sedated. You have to act fake happy all day. You run a business with staff that are living by paycheck. You have no peers on a daily basis. You have patients threatening you with bad reviews. You’ll have colleagues that are scam artists. The whole profession just has a cloud over it in general. It wears on you.

Is it worth it? For some yes, for some no. I’m 6 years out, and it stopped being fun about 4 years ago. I really enjoyed it in school and the beginning. After dealing with some real jerks it became less fun. Ive turned into a colder person dealing with these people on a daily basis. It’s just not a great atmosphere long term. The highs are very muted.

I think it’s a good profession if you are naturally outgoing, and small town type of person. If you are introverted it will wear you down. If you live in a city it’s a grind. If you are an associate long term, forget it.

One thing you start to realize as you cross paths with other people, there are many ways to make a living. You don’t have to be doctor/lawyer. We have zero benefits and no pension. There is no windfalls. It is hard to scale. You just grind it out until retirement.

For 500k I would say you have to have a very specific plan. If you are just looking for a job, forget it. $600/day associate job ain’t gonna cut it. This level of debt requires motivated ownership. And you will drop another 500k-1mil to buy a decent practice.

Some guys will kill it no doubt. A small number. Guys like tanman are extreme outliers. I have a friend like this, it’s not realistic to think everyone can do it. It’s a certain personality type.

Really though, it doesn’t matter what we say. You will rationalize your way into the profession, I know, I was there once. Just make sure you have some good hobbies for your free time.

This is one of the most honest things I have read about dentistry. If you are considering this profession please take these words seriously. I stumbled upon this forum and post and let me add a few things (I am a recent grad and specialist 2 years out of a specialty program and 4 years of school):

Do not underestimate this debt. 400-500k is crippling.

I would not consider dentistry for this amount of debt if you have any inclination that you want to live in a desirable major city (this includes suburbs of a major city). Almost all cities are saturated. If you are from california or new york like me and cannot see yourself living anywhere else (like me) I beg you to reconsider other options. I would not do this profession for any debt over 300,000 (pushing it) if you wish to live in NY/LA/SF. Engineering, business, medicine, hell even fashion have a greater job outlook in LA/NYC, unfortunately dentists are a dime a dozen.

At the end of the day remember in dentistry business is king, you are learning a skill which ultimately you must learn business to UTILIZE this skill. This is much different than medicine or other professions in which you learn a skill and the majority of jobs are hospital/corporate based etc etc (which is good and bad) and you do not have to worry about business/selling/marketing as much. Some personality types can prefer this, not everyone can be successful in business even if you are outgoing etc.

Realize if you are from a working class family who grew up with less and had to fund everything involving your education (like me), at least in my experience, you may feel isolated in this profession. A majority of my classmates were from upper class families/parents are doctors/lawyers/dentists and who will not share the same debt burden and stress as you will.

Jobs are not plentiful in desirable areas. I know many friends that had to move out of their desired locations (LA, NY, SF, Miami, DC etc) into smaller towns just to find a decent job. Do you want to pursue a profession that may force you to move to some place you don't want to be to make money all the while having the big debt boogie man looming? No.

As an associate at the majority of jobs, if you don't see a patient you do not make money. If you get sick or can't get to work you do not make money. If you want to take a vacation or leave for a day for a family issue, you do not make money. If you have a string of cancellations, you don't make money. Finally, if you don't make money, it doesn't matter, malpractice, disability, loan payments, they don't go away,
Sometimes it does feel like you are kind of a prisoner to this profession by your own doing. Not trying to be a debbie downer but this is reality. In comparison I have friends in nursing, PAssting, real estate, business, engineering, with benefits, paid time off, less liability, minimal or no loans etc. If they want to call in a sick day to go to Aruba on a long weekend they can. Remember, dentistry is not this same medical or large corporate model, its more akin to running a small business, something I think a lot of students overlook, myself included way back when I choose dentistry as a career.

Dentistry can be a great career, but honestly those that I know who are happiest/make the most got really lucky, live in small town USA, joined the military, or had parents fund their education. If this sounds like you, great, otherwise I may take my luck elsewhere.

 

[2TH MVR]

Welcome dentistspec123. Great post. Dentistry is about running a small business and if you do not fully accept this .... it will be difficult for you. I'm curious if you think that this current environment dentists are in .... is new and different from past downturns? My guess is yes. Prior to 2006 .... I purchased my 1st ortho practice. Bought a small business condo and started 3 separate ortho practices from SCRATCH in the greater Phoenix metro area. Life was GOOD. When business is good .... and you're making plenty of $$$$ .... the headaches of running a small business seem irrelevant.

But this all changed after 2006. The recession. Things really never got back to the way it was prior to 2006 ... at least for myself. I mentioned previously that maybe this dental economy is cyclical as most things are. Maybe we are just in a dental downturn. But I'm not so sure. The dynamics are different. I also have to mention that I am 55 and of course ... with age ..... I'm starting to slow down, but not much .

If someone asked me. What is the biggest culprit? I would say over-saturation. Too many dentists in the desirable areas all competing with each other. So, the holy grail would be? Less DS debt and working in less saturated, less competition rural area ... wherever that may be.

 

[LFA20]

Welcome dentistspec123. Great post. Dentistry is about running a small business and if you do not fully accept this .... it will be difficult for you. I'm curious if you think that this current environment dentists are in .... is new and different from past downturns? My guess is yes. Prior to 2006 .... I purchased my 1st ortho practice. Bought a small business condo and started 3 separate ortho practices from SCRATCH in the greater Phoenix metro area. Life was GOOD. When business is good .... and you're making plenty of $$$$ .... the headaches of running a small business seem irrelevant.

But this all changed after 2006. The recession. Things really never got back to the way it was prior to 2006 ... at least for myself. I mentioned previously that maybe this dental economy is cyclical as most things are. Maybe we are just in a dental downturn. But I'm not so sure. The dynamics are different. I also have to mention that I am 55 and of course ... with age ..... I'm starting to slow down, but not much .

If someone asked me. What is the biggest culprit? I would say over-saturation. Too many dentists in the desirable areas all competing with each other. So, the holy grail would be? Less DS debt and working in less saturated, less competition rural area ... wherever that may be.

Military

 

[DocJL]

Military

If they pay for your school, it's a good deal.

But if you are not prior service and haven't been IN the military, you may find that military dentistry isn't all that the recruiter advertises it to be (from a former Navy dentist, GPR and 3 years with the Marines).

 

[TheDarkSSC]

If I had to re-do it, would definitely do a military scholarship. Being debt free is priceless. Dave Ramsey brainwashed me..

 

[Medin2017]

I wouldn't do it for 500k, but dentistry seems like a pretty sweet gig if you like what you're doing. It's like making people healthier/feel better while doing arts and crafts at the same time. General dentistry itself is neat because it seems you can continue learning more and adding or removing things you like/don't like to your daily practice. Take it with a grain of salt since I'm a D1, but this semester has definitely changed my view on whether I want to specialize or not, and not because I did poorly. I recommend assisting and shadowing in free time and talking to mentors. It will definitely open your mind. I bet being out in the real world may be different though, who knows.

 

[TanMan]

If I had to re-do it, would definitely do a military scholarship. Being debt free is priceless. Dave Ramsey brainwashed me..

Not all debt is bad debt. Debt that allows you to grow and make more money is good debt. Dental school tuition is like an initiation fee - grants you the right to the practice dentistry. Now, that fee varies depends on your tuition, but puts you a slightly exclusive club known as being a dentist.

As long as the debt that you acquire returns a positive return, it can be considered good debt (absolutely speaking). Relatively speaking, there's always more than one way to use borrowed funds for investments. 500k is steep for an initiation fee, but not much in the grand scheme of your dental career. You'll make way more than that and then some... Don't fear debt and embrace the fact that you can go into debt to pursue a career and other entrepreneurial activities. Could you imagine if you had to pay for everything in cash? We would not have the opportunities that we have today such as home ownership or starting a business.

 

[dentistspec123]

Welcome dentistspec123. Great post. Dentistry is about running a small business and if you do not fully accept this .... it will be difficult for you. I'm curious if you think that this current environment dentists are in .... is new and different from past downturns? My guess is yes. Prior to 2006 .... I purchased my 1st ortho practice. Bought a small business condo and started 3 separate ortho practices from SCRATCH in the greater Phoenix metro area. Life was GOOD. When business is good .... and you're making plenty of $$$$ .... the headaches of running a small business seem irrelevant.

But this all changed after 2006. The recession. Things really never got back to the way it was prior to 2006 ... at least for myself. I mentioned previously that maybe this dental economy is cyclical as most things are. Maybe we are just in a dental downturn. But I'm not so sure. The dynamics are different. I also have to mention that I am 55 and of course ... with age ..... I'm starting to slow down, but not much .

If someone asked me. What is the biggest culprit? I would say over-saturation. Too many dentists in the desirable areas all competing with each other. So, the holy grail would be? Less DS debt and working in less saturated, less competition rural area ... wherever that may be.

I cannot say if this current environment is any different than in the past or prior to 2006 as I graduated dental school in 2014 and am kind of freshly out. However, I do feel like the current climate (I am speaking the dental climate viewpoint from a major city/suburb as a newer grad and associate, I am aware that dentistry is still pretty good in small towns and certain pockets of the US and if you had low enough debt to open a practice immediately) is due to a multitude of factors, large debt being one of them. For sure oversaturation is an issue. Look at southern california where the average GP associate base salary is 400$ a day and for my specialty (pedo) absolutely nobody is hiring in decent areas. I have quite a few pedo friends from socal who wished to return and could not find decent jobs or have to work odd days/3-4 part time jobs just to survive or moved to the desert in arizona or new mexico to work and gave up. Additionally, schools are not stopping tuition increases and more are opening, Touro college near NYC just opened last year, which will surely flood NYC with an unnecessary 100 or so graduating dentists a year.

For anyone considering dentistry it is easy for you to check the job market, if you think you want to be in XXXXX city or town look up jobs on craigslist, indeed, or respective dental group boards (AAPD for me or ADA or your states dental society) for jobs/practices for sale. A quick search for pediatric dentist in SoCal for example yields very few results and is disproportionate to the actual supply. This is troublesome.

Moreover, the large debt (averaging I believe 290,000 for a dental grad in the last articles I have read) should be worrisome to all. However, this is not the case, I find that veterans in dentistry nearing the age of retirement and the majority of practice owners are pretty clueless and apathetic as to the actual implications of this debt and a "well they can work hard and pay it off" toward new grads attitude is pretty standard. This innate greed and apathy leads to the older generation of dentists (who are, face it, mostly the ones with the successful small businesses hiring new grads) offering low base pays and an oversupply of desperate debt burdened new grads taking any job they can get. I forsee a terrible cycle with this and a rude awakening for older dental business owners who find they cannot sell their practices as new grads cannot afford/are more scared to take on more debt to buy practices and thus will sell to corporate industries, compounding the issue.The trajectory dentistry is currently on will be unpredictable in my opinion, and something will have to give. If it means a debt bubble burst, or the majority of the profession selling out to corporate entities, I am not sure, time will tell I guess.

I am not sure of a holy grail but definitely for anyone pursuing dentistry, keep your debt low. Cheapest school you get in to PERIOD. No school is worth an extra 50, 100, or 200k. Consider military or small town life after graduation if you can hack this, unfortunately I cant (did pedo in a small town and was pretty miserable outside of residency, sorry it isnt for everyone). Also remember, small business mindset, get involved in the business aspect, learn about how to maximize coding for profits, lower material costs without compromising care etc etc. Dental school will not teach you this, you must be active and diligent in the business aspect. If this is not for you or doesnt sound like you, I would consider something else.

 

[DDS9994]

Not all debt is bad debt. Debt that allows you to grow and make more money is good debt. Dental school tuition is like an initiation fee - grants you the right to the practice dentistry. Now, that fee varies depends on your tuition, but puts you a slightly exclusive club known as being a dentist.

As long as the debt that you acquire returns a positive return, it can be considered good debt (absolutely speaking). Relatively speaking, there's always more than one way to use borrowed funds for investments. 500k is steep for an initiation fee, but not much in the grand scheme of your dental career. You'll make way more than that and then some... Don't fear debt and embrace the fact that you can go into debt to pursue a career and other entrepreneurial activities. Could you imagine if you had to pay for everything in cash? We would not have the opportunities t we have today such as home ownership or starting a business.

I would caution dental students against the good debt versus bad debt mindset, its all debt, some of it is just a whole lot worse than others. 500K with interest is huge in the grand scheme of things and you cant simply walk away from it thru bankruptcy.

 

[DDS9994]

I cannot say if this current environment is any different than in the past or prior to 2006 as I graduated dental school in 2014 and am kind of freshly out. However, I do feel like the current climate (I am speaking the dental climate viewpoint from a major city/suburb as a newer grad and associate, I am aware that dentistry is still pretty good in small towns and certain pockets of the US and if you had low enough debt to open a practice immediately) is due to a multitude of factors, large debt being one of them. For sure oversaturation is an issue. Look at southern california where the average GP associate base salary is 400$ a day and for my specialty (pedo) absolutely nobody is hiring in decent areas. I have quite a few pedo friends from socal who wished to return and could not find decent jobs or have to work odd days/3-4 part time jobs just to survive or moved to the desert in arizona or new mexico to work and gave up. Additionally, schools are not stopping tuition increases and more are opening, Touro college near NYC just opened last year, which will surely flood NYC with an unnecessary 100 or so graduating dentists a year.

For anyone considering dentistry it is easy for you to check the job market, if you think you want to be in XXXXX city or town look up jobs on craigslist, indeed, or respective dental group boards (AAPD for me or ADA or your states dental society) for jobs/practices for sale. A quick search for pediatric dentist in SoCal for example yields very few results and is disproportionate to the actual supply. This is troublesome.

Moreover, the large debt (averaging I believe 290,000 for a dental grad in the last articles I have read) should be worrisome to all. However, this is not the case, I find that veterans in dentistry nearing the age of retirement and the majority of practice owners are pretty clueless and apathetic as to the actual implications of this debt and a "well they can work hard and pay it off" toward new grads attitude is pretty standard. This innate greed and apathy leads to the older generation of dentists (who are, face it, mostly the ones with the successful small businesses hiring new grads) offering low base pays and an oversupply of desperate debt burdened new grads taking any job they can get. I forsee a terrible cycle with this and a rude awakening for older dental business owners who find they cannot sell their practices as new grads cannot afford/are more scared to take on more debt to buy practices and thus will sell to corporate industries, compounding the issue.The trajectory dentistry is currently on will be unpredictable in my opinion, and something will have to give. If it means a debt bubble burst, or the majority of the profession selling out to corporate entities, I am not sure, time will tell I guess.

I am not sure of a holy grail but definitely for anyone pursuing dentistry, keep your debt low. Cheapest school you get in to PERIOD. No school is worth an extra 50, 100, or 200k. Consider military or small town life after graduation if you can hack this, unfortunately I cant (did pedo in a small town and was pretty miserable outside of residency, sorry it isnt for everyone). Also remember, small business mindset, get involved in the business aspect, learn about how to maximize coding for profits, lower material costs without compromising care etc etc. Dental school will not teach you this, you must be active and diligent in the business aspect. If this is not for you or doesnt sound like you, I would consider something else.

The only part I disagree with you is that the older generation is apathetic. I only see the guys in the Ivory towers of school administration who say " its no big deal" but the guys out in the trenches like myself who have been out for over 10 years continue to be bewildered when new grads shell out over 300K plus for dental school. I find most of the newbs don't think its a big deal until it is. In fact plenty of us who are older have been accused over and over again of being "doom and gloom" when we say " you need to think this thru a bit more, 450K loans is a massive burden." I agree with Tan Man in that you better have an airtight plan and some great business skills if you plan on paying off 500K and having a good life.

 

[gn4]

Depends. If you specialize(depends on the specialty), I think it's worth it. Always go to the cheapest school.

 

[2TH MVR]

The Corp practices are just going to keep growing and growing. They provide exactly what the younger generation wants. Convenience. Everything under one roof. Why would a patient who has trust in their GP want to go outside and see one or two different specialists for an implant? 2-3 different bills. If under one roof .... one consolidated bill.

Dentistry (especially orthodontics commonly referred by people as just "Braces") is rapidly becoming commoditized. What's a set of braces cost? Down the street .... you can get braces for under $3000. In Corp .... patients don't even care about my experience (26 plus years) or qualifications. As long as the price is right and they can finance the treatment.

The point I'm making is that bright students once chose dentistry because of the lifestyle and the ability to own your own practice (be a small business owner). With all the high DS debt and the commoditization of dentistry .... owning your own practice seems to be getting harder and harder. Dentistry seems to be heading in the same path that medicine is in now. Corporate and insurance controlled.

There is hope. All this commercialization of dentistry is happening mostly in the saturated, urban areas. I believe, as others have pointed out, that the traditional model of providing quality, personable dentistry can still thrive in those under-served, rural areas.

 

[321931]

I'm going to give some specific examples on how and where you can save money... (If these links are in violation of TOS, please let me know, I'll take them down. These are not referral links to make money)
Air Compressor w/ air filter
Ingersoll Rand Reciprocating 60 Gal. 5 HP Electric 230-Volt with Single Phase Air Compressor-SS5L5 - The Home Depot
Dryaire Desiccant System by Sharpe
Cheap Countertops
Hampton Bay Valencia 10 ft. Laminate Countertop in Typhoon Ice-495252V10 - The Home Depot
Vacuum: Used vacuums work well to start cheap.
Flooring: VCT or laminate
Computers: Refurbished dell computers from Newegg or other places
Radiographs: Get a refurb pano from renewdigital, go buy used sensors (you don't need top of the line, you just need them diagnostic enough to diagnose and bill out). Sensors that come to mind are the Gendex eHD's. Old generation, but less than 1k each.
Xray: Go buy a Nomad. A used nomad can be had for around 2500-3500. Makes every room an xray room.
Piezoscaler: Woodpeckers are cheap for scalers and light curing units.

- You don't need a "dental plumber", any plumber will do. Edit: Avoid most professions with the word dental preceding their profession, such as dental lawyer, dental cpa, dental IT, etc...
- Plumb overhead, avoid breaking ground. Save money, easy repairs.
- No sinks/drain in your rooms
- No overhead lights, cuspidors, rear delivery everything. All you really need in a room is a countertop, rear delivery, chair, computer/monitor, TV, handpiece and piezo connection. Cabinetry is optional, depending on your budget. Usually, residential cabinet makers are cheaper, and you can slap on a countertop afterwards.
- When looking for a new spot, look for a business that closed that has a bathroom already that does not need to be moved. Moving a bathroom can be costly, having an existing bathroom saves lots on plumbing. Even better if the closed business has vent ducts w/ AC unit.
- Lighting: go with cheap commercial lighting for now, you can add recessed lighting later on, costs add up.
- Furniture: Go look for stores that sell slightly defective, returned, or repossessed furniture. Save lots of money on couches, chairs, tables, etc...
- Printer: Have a color and b&w ink printer. Color when you have to send photos for claims (there are still some insurances that want us to mail photos!), b&w for everything else. The killer here is not the printer, but the ink. I have an epson r4640 and multiple canon lbp6670dn. Why? Ink is supercheap, cost per page is very low.
- Cables: Monoprice... any cable, every cable. When setting up your network, you can throw the cables down yourself leading to the server and intended room while they are still framing and doing electrical. Ask your contractor to make a conduit before they sheetrock the walls.
- Need a logo? Crowdsource your logo! One that comes to mind is zilliondesigns.com, I can't remember the other one. You don't have to pay an arm and a leg for your "brand identity". Another BS moneymaking scheme that fleeces dentists.

Anyway, I'm going on a massive tangent, I'm just listing whatever comes to mind, but when I look at the amounts people splurge on "dental" or "commercial/professional" products, it's ridiculous how much the markup can be.

So... after cutting costs everywhere, I was able to get it a little above 100k. Now, the disclaimer is that you'll need to spend more to upgrade because durability is not as high as alternatives. However, at this stage of practice startups, it's more important to be able to start producing than the appearance and color scheme of your office.

Now, how to get 100k production. You need to have the capacity to handle 100k+ production levels and bring patients in. Average family size is 3-4 members. You need at least 3-4 chairs that are hygiene compatible so that you can see them in an hour slot. For ops, anything less than 3 chairs is a bottleneck. Imagine if you are trying to juggle 2-3 ops at the same time and you get an emergency patient come in. Overflow rooms are important to make sure that patient is seen, services rendered, and get the patient out of pain. The lesson here is that you should have at least 6 rooms ready, bare minimum of 2 ops, 4 hygiene, but I would prefer to have 3 ops that can be converted to hygiene and 3 hygiene exclusive room to start off.
You might ask, how do I get the patients in? Offer them something that everyone else isn't offering (mine is convenience, lots do price) and advertise the hell out of it. Most effective ad mediums are TV, radio, local celeb endorsements, adwords. Print media is horrendously ineffective from my experience. Social media is a double edged sword. If you build your practice on social media, you can grow cheap, but you can also be taken down rather easily.

I'm going to have to totally disagree with this post.

Is a start-up risky? yes
Is a start-up at 100k and getting 100k production even more ridiculous? Yes. The average dental practice produces 700k a year. A million dollar practice is not easy to do.

I know many people on this forum are so older dentists and alot of dental students, but this is just feeding the mentality of the 4 day week, easy to own, easy to make money dentist lifestyle.

This is the reality of most start-ups. You end pouring 200-300k, or if you want to go high-end 500k. You open the doors, and nothing comes in. You hire a bunch of staff and can't pay them well. So they end up going to "good" offices that can afford them the benefits that they need. So you have staff turnover. You have no patients. You have student loans to pay off. You probably have a newly wed and kid to. So you end up working 3 days at your own office dealing with no cash flow, staff turnover, and then have to work in some mill for 2-3 days a week to keep your personal budget afloat. Maybe year 1 you barely break even. Maybe year 2 you barely break even. Maybe year 3-4 is your breakout period and make some money and drop your part time job to do 4 days week. You haven't touched your principal on your loan yet, and you haven't made dent on your debt.

The upside is that you choose a spectacular location, pour X amount into building an office and you take off running. Everyone's dream. DREAM. All the corps are thinking the same way as you; however, you have much less buying power and money to take off running. Maybe you do hit it big, but the chances are very minimal. Most likely you will be stuck in the crappy start-up making barely ends meet. And then I will see on brokers website "Turnkey practice for SALE, NEW EQUIPMENT, beautiful buildout!, collecting 300k a year on 3 days a week, owner relocating, or health issues, won't last long!." We all know that's a failed startup. I know because I know a few classmates that work 5-6 days a week in their startup and make less then 100k. One wants to cut his losses and go to community health.

Do yourselves a favor and do your homework on why an existing practice is a much easier and safer bet to buy. NOTHING in life is easy. If it SOUNDS to good to be true, then guess what, IT IS TO GOOD TO BE TRUE. 100k startup, 100k production. No way dude.

 

[charlestweed]

I am not sure about the convenience when getting treatments at the corp. Many patients leave the corp offices because of overbooking, long wait time, lazy staff who don’t care, specialists who only come in a few days a month etc, associate dentists who don’t care (because they don’t own the practice), poor communications etc. Every time I try to call the Western Dental’s general dentist regarding the tx of our mutual patients, the receptionists put me on hold for at least 5-10 minutes. We, private practioners, can compete against these corp by offering better fees, friendlier staff, better doctor-patient relationship, and less wait time. The key is to keep the overhead as low as possible.

I like TanMan’s “start cheap, upgrade later” approach. Why spend the money you don’t have (it’s the bank’s money) so you can have an efficiently run office? There are a few leasehold sales here in CA that cost as low as $25k. At the beginning, your appointment book will be very empty; therefore, being efficient shouldn’t be the #1 priority. Instead, you should spend time talking to patients and taking good care of them so they’ll refer more patients. Once your office picks up more patients, you have more cash flow, you can hire more staff to do all the talkings for you and you can buy anything (CBCT, intraoral scanner etc) you want. The pateints don’t care what you use. Honest doctor, low cost treamtents and good clinical results are all they care about.

 

[321931]

I am not sure about the convenience when getting treatments at the corp. Many patients leave the corp offices because of overbooking, long wait time, lazy staff who don’t care, specialists who only come in a few days a month etc, associate dentists who don’t care (because they don’t own the practice), poor communications etc. Every time I try to call the Western Dental’s general dentist regarding the tx of our mutual patients, the receptionists put me on hold for at least 5-10 minutes. We, private practioners, can compete against these corp by offering better fees, friendlier staff, better doctor-patient relationship, and less wait time. The key is to keep the overhead as low as possible.

I like TanMan’s “start cheap, upgrade later” approach. Why spend the money you don’t have (it’s the bank’s money) so you can have an efficiently run office? There are a few leasehold sales here in CA that cost as low as $25k. At the beginning, your appointment book will be very empty; therefore, being efficient shouldn’t be the #1 priority. Instead, you should spend time talking to patients and taking good care of them so they’ll refer more patients. Once your office picks up more patients, you have more cash flow, you can hire more staff to do all the talkings for you and you can buy anything (CBCT, intraoral scanner etc) you want. The pateints don’t care what you use. Honest doctor, low cost treamtents and good clinical results are all they care about.

Yeah we can both agree about the corp situation, but there are ton of private practices that are efficient at spending time talking to patients, taking good care of them, with great staff to boot. What you are suggesting is reminiscent of the days where if you hang a shingle, put your name on the yellowbooks, patient's will come to you, and you will be fine. That was great a long time ago. Not in today's climate.

 

[TheDarkSSC]

Not all debt is bad debt. Debt that allows you to grow and make more money is good debt. Dental school tuition is like an initiation fee - grants you the right to the practice dentistry. Now, that fee varies depends on your tuition, but puts you a slightly exclusive club known as being a dentist.

As long as the debt that you acquire returns a positive return, it can be considered good debt (absolutely speaking). Relatively speaking, there's always more than one way to use borrowed funds for investments. 500k is steep for an initiation fee, but not much in the grand scheme of your dental career. You'll make way more than that and then some... Don't fear debt and embrace the fact that you can go into debt to pursue a career and other entrepreneurial activities. Could you imagine if you had to pay for everything in cash? We would not have the opportunities that we have today such as home ownership or starting a business.

All totally valid points. Being debt free other than home as just made my life so much easier. I am able to sock away six figures a year towards retirement now at age 32. I agree with ramsey only on personal finance but not with investment/business strategy such as your describing.

 

[Shunwei]

A lot of good information along with a lot of misleading information in this post. Endoaccess’ post was best and Tanman was the worst.

The most misleading information is how everyone should be an owner. I can’t believe no one can see that if everyone were indeed an owner, what would happen in a supply and demand sense. It’s already happening in most areas where dental offices are like nail salons.

And this is not even to mention that the majority of people are really not even fit to run a business.

Of course none of this matters. Pre-dents will find an excuse to do whatever they want. And that’s fine because it’s their choice. But I bet 90% of them will regret it in 5-6 years when they got debt up their wazoo and nowhere to run.

 

[321931]

A lot of good information along with a lot of misleading information in this post. Endoaccess’ post was best and Tanman was the worst.

The most misleading information is how everyone should be an owner. I can’t believe no one can see that if everyone were indeed an owner, what would happen in a supply and demand sense. It’s already happening in most areas where dental offices are like nail salons.

And this is not even to mention that the majority of people are really not even fit to run a business.

Of course none of this matters. Pre-dents will find an excuse to do whatever they want. And that’s fine because it’s their choice. But I bet 90% of them will regret it in 5-6 years when they got debt up their wazoo and nowhere to run.

I’m more in shock at the notion of a 100k start up producing 100k. You need ridiculous business acumen, clinician capability, leadership ability and of course luck on top of all that. And of course a lot of the dental students eat it up yum yum. Let me tell you this, a good practice can finance all your loans, pay all off within 10 years with way way way less risk.

 

[charlestweed]

I’m more in shock at the notion of a 100k start up producing 100k. You need ridiculous business acumen, clinician capability, leadership ability and of course luck on top of all that. And of course a lot of the dental students eat it up yum yum. Let me tell you this, a good practice can finance all your loans, pay all off within 10 years with way way way less risk.

I guess it depends on who you ask. If you ask the successful private practice owners, they’ll say yes it is worth it. But if you ask GPs who work for corp offices or own a failing practice, they’ll probably say no. Not all dentists are created equal. Some have better clinical and business skills than others.

There are a couple of SDN members (ie TanMan, Coldfront, Daurang etc) here, who started their offices from scratch and are doing extremely well. I remember when I started my first office from scratch 12 years ago, I didn’t really notice any drop in my income (due to additional business expenses) because I continued to work F/T at the corp...and I worked at my office on weekends. The same thing was true for my sister, who is a GP and spent less than $100k to set up her office from scratch. At the beginning when her new office didn’t have enough patients, my sister continued to work 4 days/week for the corp and spent the other 3 days/week (Saturdays and Sundays are the 2 most productive days of the week) to work at her own office. That’s how my sister continued to earn a 6-figure income even when her new office didn’t have a lot of patients at the beginning. Now, my sister no longer works on Sundays...nor for the corp.

 

[TanMan]

Clearly there's a divide on practice startup v. acquisition. I was going to quote each one and address each point, but I'd rather address everything as a whole.

If you're going to acquire that much debt, you better have a plan to make a ton of money. I'm not saying being an associate is a dead-end route, but you sure as hell are going to do a lot of dentistry to make that money. If you have no ethics and are willing to churn every patient, you can pay off your loans in no time at a corporate place, assuming that they have the patient flow. However, your treatment philosophy becomes more aggressive, the more desperate your financial situation becomes. The alternative routes are military, practice ownership via acquisition or start-up.

Not everyone is cut out to be an owner, but if you're not willing to study and learn the fundamentals of business, you better be quick with your hands (refer to paragraph 2). I know some successful people that did the pump and dump scheme, and that's one of the downfalls of owning multiple practices... cleaning up the mess of your associates. Being an owner isn't easy, and acquiring/starting a practice has its pros and cons. I hate the idea of expensive acquisitions because I don't like the idea of being tied to paying down a note for which goodwill is typically grossly overvalued in the practice. You might have a running start, but it's like you have a lead ball stuck to your foot.

And yes... there are people who have failed startups, that's with any business. Can you fail with an acquired practice? Yes, you can, especially if you don't do your due diligence or numbers/data are misrepresented. Can you initiate a lawsuit? Definitely, but if you're overleveraged in your resources, chances are that you may not be able to afford good legal representation.

Now, seems to be the common theme of attacks is that startups are risker, getting people's hopes up unrealistically. There's nothing wrong with saying you can startup with 100k. You can start a practice with 100k+, regardless of what gurus and practice management people say. Otherwise, you're just drinking their kool-aid to get you to buy overpriced products. Can you produce over 100k in a few months after opening? Yes you can, sample size of 1 (2 if you count another colleague of mine, 10 months later). You're probably not going to live in the most desirable of cities due to an oversupply (Just because you have DDS/DMD after your name doesn't make you special) and law of economics still apply. Breaking into a market where there's oversupply makes no sense and buying a practice in a saturated market does get your foot in the door, but expansion potential is still lower compared to a less saturated market.

However, with all things said, patients aren't going to just end up in your lap just because you opened an office. Buying a practice already has existing patients but the fact remains whether you purchase a practice or startup. Both have the facilities to allow you to practice (which I find the most important). Purchasing a practice gets you preexisting patients who most likely have been drained of treatment already and possible goodwill, or negative goodwill, depending on the practice reputation... do I think the price premium is worth the revenue stream that an existing practice provides? No, in most cases. I'm a keen believer in advertising. It's part of the machine that keeps on churning and delivers new patients that have a lot more potential for treatment.

Be prepared to roll up your sleeves and work your ass off regardless of the path that you take. I just think that if you're going to go all out with your efforts, you might as well start up your own practice. More risk, more return. You want to go the slow and steady route? Purchase a practice.

 

[kingme23]

People criticizing @TanMan message clearly have not read up on his full story. He’s never suggested that everyone can open a start up and within months you’ll be making easy money and casually seeing patients throughout the day while surfing the internet between appointments. The impression I get is that he works hard, really hard and puts way more money into advertising than the average dentist. I.E. working out of 3-4 ops at a time while having hygiene ops running simultaneously. If someone has good business sense and works that hard, I think their chances of success are pretty damn good. Also, this is in a suburb, not a supersaturated area like SoCal/NYC etc.

Unfortunately not everyone has what it takes to succeed in a startup. You can already get a gauge of this during dental school, when you see classmates that are super slow, need their hand held at all times, have no clinical confidence, don’t know a thing about money, etc. So saying that there is only 1 smart way is untrue. Buying an existing practice for those people would be smarter since the ground work is already laid. But for the right people, laying their own groundwork via cheap startup could set them up for much more success/less stress.

 

[2TH MVR]

Definitely different ways to do dentistry. Agree that it takes the right combination of business sense, gunner mentality, hard work and probably the most important variable is location. The problem with most start ups is that you have no idea how to do it. I started 2 practices from scratch. Thought I knew everything. On my last start up ..... I made the mistake of not getting partial lein releases from the subcontractors. General filed bankruptcy and I was on the hook for the unpaid debt to the subs even though I had paid the General. I successfully negotiated wiht the subs to lower the unpaid debt. All lein releases are mine now. Point is .... even with experience .... **** happens.

When I graduated from ortho ... I had no idea how to run an ortho practice. My time associating, partnership and eventual buyout of a practice was invaluable. Eventually with experience .... I started to expand.

For every @TanMan .... there are many dentists that fail to meet expectations. Not necessarily complete failure .... but essentially living a lifestyle that is comfortable, but not lavish.

What some posters are saying is take what @TanMan recommends within context. His system works well because of HIM and his location. Take HIM and his location out of the picture and what do you have?

This forum is lucky to hear some advice from a dentist that is successful.

 

[DDSER1]

Definitely different ways to do dentistry. Agree that it takes the right combination of business sense, gunner mentality, hard work and probably the most important variable is location. The problem with most start ups is that you have no idea how to do it. I started 2 practices from scratch. Thought I knew everything. On my last start up ..... I made the mistake of not getting partial lein releases from the subcontractors. General filed bankruptcy and I was on the hook for the unpaid debt to the subs even though I had paid the General. I successfully negotiated wiht the subs to lower the unpaid debt. All lein releases are mine now. Point is .... even with experience .... **** happens.

When I graduated from ortho ... I had no idea how to run an ortho practice. My time associating, partnership and eventual buyout of a practice was invaluable. Eventually with experience .... I started to expand.

For every @TanMan .... there are many dentists that fail to meet expectations. Not necessarily complete failure .... but essentially living a lifestyle that is comfortable, but not lavish.

What some posters are saying is take what @TanMan recommends within context. His system works well because of HIM and his location. Take HIM and his location out of the picture and what do you have?

This forum is lucky to hear some advice from a dentist that is successful.

As a first year dental student I've come to realize this is the fundamental truth. Dentistry is extremely anecdotal, but beyond that picking the right selection seems to be the most important decision. In Ontario, Canada, where I'm from, practices sell for 150-200% of collections because of lack of supply, so I personally want to start up my own practice rather than take on 1-2mil of debt. I have no problem moving where ever the demand is, but I have a question for the owner dentists though:

How many owner docs would actually rather sell their practice to a new grad, than to a corp that can offer them more money? It seems like everyone is afraid of the corps taking over, but docs continue to sell their practices to them because they outbid everyone else.

 

[schmoob]

A lot of good information along with a lot of misleading information in this post. Endoaccess’ post was best and Tanman was the worst.

The most misleading information is how everyone should be an owner. I can’t believe no one can see that if everyone were indeed an owner, what would happen in a supply and demand sense. It’s already happening in most areas where dental offices are like nail salons.

And this is not even to mention that the majority of people are really not even fit to run a business.

Of course none of this matters. Pre-dents will find an excuse to do whatever they want. And that’s fine because it’s their choice. But I bet 90% of them will regret it in 5-6 years when they got debt up their wazoo and nowhere to run.

Weren't you just recently talking about how you managed to pay off $270K in student loans in 12 months because of your practice?

 

[InformMe123]

Whats the thoughts on pursuing dentistry for the dental specialties?

 

[TanMan]

People criticizing @TanMan message clearly have not read up on his full story. He’s never suggested that everyone can open a start up and within months you’ll be making easy money and casually seeing patients throughout the day while surfing the internet between appointments. The impression I get is that he works hard, really hard and puts way more money into advertising than the average dentist. I.E. working out of 3-4 ops at a time while having hygiene ops running simultaneously. If someone has good business sense and works that hard, I think their chances of success are pretty damn good. Also, this is in a suburb, not a supersaturated area like SoCal/NYC etc.

Unfortunately not everyone has what it takes to succeed in a startup. You can already get a gauge of this during dental school, when you see classmates that are super slow, need their hand held at all times, have no clinical confidence, don’t know a thing about money, etc. So saying that there is only 1 smart way is untrue. Buying an existing practice for those people would be smarter since the ground work is already laid. But for the right people, laying their own groundwork via cheap startup could set them up for much more success/less stress.

I think you hit the point dead on. Try juggling 13 rooms all at once... I didn't get there all of a sudden but eventually evolved to being able to run from room to room (although I am skeptical whether I can add more rooms and keep seeing the patients myself). If you're not willing to push yourself to the max, then you are not fulfilling your full production potential in your practice. I don't take lunch/meal breaks since they tend to make me sluggish. Not a fan of bathroom breaks since it takes valuable time and reduces my 100% focus on getting patients in and out. I'd rather be busy and realize that the day's over than sit in my desk waiting for the next patients. There's a hint of obsession over getting patients in and out, but when you have an almost neverending quota of patients to see, you'll have no choice but to keep going or sink.

If you're looking at seeing 10-15 regular patients a day (recalls and some treatments/not super extensive treatments), then you may be stuck in a cycle of mediocrity. If you're willing to push yourself and just keep going without giving up, you can definitely run a multimillion dollar solo practice. I know a lot of dentists who are fitness buffs and fanatics (or academic gunners), and I pose this question... if you have the willpower and discipline to workout everyday and run marathons, why don't you apply the same discipline to working as much and as hard as you can where it really counts.

I say this from a relatively younger dentist perspective and if you've read my previous posts, I tend to reiterate: when you're young, you have room to take more aggressive measures and risks for the goal of higher returns. If you mess up while you're still young, you can recover more easily than if you mess up when you're older. You don't want to be that 65 year old dentist that lost everything and forced to work. Treat your profession like an investment. When you're younger, go more aggressive.. on average, you'll come out more ahead. As you get older, you cannot absorb losses as much and you'll have to go with a more conservative approach. Also, I want to retire early. Life's too short and I want to enjoy life in my prime years, not when I'm in my 50's. Achieving this requires a very aggressive financial approach (cheap startup/ramp up, non-traditional investments, etc...). However, I also understand that not everyone graduating dental school is in their 20's ready to take on life. There's many people out there that have families and/or pursuing dentistry as a second career. Evaluate your life, evaluate your skills, and find what works best for you.

 

[deleted659902]

TanMan and other working dentists who own successful practices,

what would your strategy be if you had to open a 100% FFS practice in a major city other than NYC and SF and the likes (I'm talking about Atlanta, Cleveland, Scottsdale, Austin etc) with a goal of reaching 2M in production as a single doc office within three years? Will it be viable to reach this kind of number in this kind of scenario/location adhering strictly to crowns and restorative/non-cosmetic work (i.e. no surgery/implant/endo)?

Would purchasing a practice be wiser in this case rather than a startup? I'm assuming a lot of competitive advantages must be utilized like convenience hours, convenient location, promos, etc

 

[DocJL]

Dentistry can be very stressful in a different way. Anyone coming into this expecting stress free is in for a rude awakening. You are making a living doing something that people are afraid of, don’t like, and don’t want to spend money on. Your patients are not sedated. You have to act fake happy all day. You run a business with staff that are living by paycheck. You have no peers on a daily basis. You have patients threatening you with bad reviews. You’ll have colleagues that are scam artists. The whole profession just has a cloud over it in general. It wears on you.

Is it worth it? For some yes, for some no. .

Great post, brother.

Dentistry has provided a great standard of life for me and my family. But nothing is given to you. It's one patient, one tooth, one procedure at a time. It's hard work, physically demanding and requires 100% of your concentration at all times.

It's a tough gig.


(and I've worked many different jobs in my life)

I'm going to have to totally disagree with this post.

Is a start-up risky? yes
Is a start-up at 100k and getting 100k production even more ridiculous? Yes. The average dental practice produces 700k a year. A million dollar practice is not easy to do.

I know many people on this forum are so older dentists and alot of dental students, but this is just feeding the mentality of the 4 day week, easy to own, easy to make money dentist lifestyle.

This is the reality of most start-ups. You end pouring 200-300k, or if you want to go high-end 500k. You open the doors, and nothing comes in. You hire a bunch of staff and can't pay them well. So they end up going to "good" offices that can afford them the benefits that they need. So you have staff turnover. You have no patients. You have student loans to pay off. You probably have a newly wed and kid to. So you end up working 3 days at your own office dealing with no cash flow, staff turnover, and then have to work in some mill for 2-3 days a week to keep your personal budget afloat. Maybe year 1 you barely break even. Maybe year 2 you barely break even. Maybe year 3-4 is your breakout period and make some money and drop your part time job to do 4 days week. You haven't touched your principal on your loan yet, and you haven't made dent on your debt.

The upside is that you choose a spectacular location, pour X amount into building an office and you take off running. Everyone's dream. DREAM. All the corps are thinking the same way as you; however, you have much less buying power and money to take off running. Maybe you do hit it big, but the chances are very minimal. Most likely you will be stuck in the crappy start-up making barely ends meet. And then I will see on brokers website "Turnkey practice for SALE, NEW EQUIPMENT, beautiful buildout!, collecting 300k a year on 3 days a week, owner relocating, or health issues, won't last long!." We all know that's a failed startup. I know because I know a few classmates that work 5-6 days a week in their startup and make less then 100k. One wants to cut his losses and go to community health.

Do yourselves a favor and do your homework on why an existing practice is a much easier and safer bet to buy. NOTHING in life is easy. If it SOUNDS to good to be true, then guess what, IT IS TO GOOD TO BE TRUE. 100k startup, 100k production. No way dude.

Great post Rainee!


Especially the bolded part.


Here is food for thought.


When considering "average incomes" across the entire country, you are comparing EVERYONE in the country. MANY in the general population are dumb, and/or lazy, etc.


When looking at DENTIST average incomes, and comparing where you would like to be on that scale, consider that you are comparing yourself to people who have earned a dental degree. By definition, they possess (generally) a higher than average intellect, and have at least shown the work ethic to make it through undergrad with a high enough GPA to get INTO dental school (no small feat), and then make it THROUGH dental school.

So anyone thinking, "man no way will I have any problem doing 1.5 million a year solo practice!" is most likely setting themselves up for disappointment.

Think about it. If the average dentist GP practice does 700k, do you really think this is because the majority of dentist are lazy, clinically inept, or just bad businessmen?

Hardly. There are many smart, skilled, hardworking dentists out there giving 100% of their effort to collect that $700k.


I don't think it is possible, except in a very underserved area, to open an office and in a couple of years be bringing in $100k a month (collections, NOT "production", which based on how it is defined, can have little meaning relative to reality). I DO know guys who have done it, BUT ONLY IN UNDERSERVED RAPIDLY GROWING AREAS. Think Vegas 15-20 years ago. Texas oil country 10 years ago (not Dallas or Houston, think Midland or the areas around it. etc, etc. Not even sure what areas are "booming" for dentists now.


For the specialist who have shared on this thread, great info, but for those who are contemplating practice as a general dentist, recognize that their experience has little bearing on building or running a successful general dental office. Again - look at the medians/averages; specialists make twice, and often more than twice what general dentists make, and they simply do NOT have the competition that a general office has, nor do they spend their days doing small $ procedures. Doing those small $ procedures all day long, day in and day out, takes a toll on any dentist.

 

[Munks]

I'm going to give some specific examples on how and where you can save money... (If these links are in violation of TOS, please let me know, I'll take them down.

I recently converted an existing, 20+ year old, 1741 sf medical office to a 7-chair ortho office for only $50k.

Between Tan & CTweed, your continued advice on how to build out a startup for cheap is some of the most insightful info I get from this site. Didn't see how I missed your post earlier @TanMan but thanks for sharing specific examples, the specifics definitely help. Eg- one thing I definitely think I'll be doing is getting a refurb/older pan & ceph, and I suppose refer to a nearby OS for CBCTs if need be~~ lots to think about.

 

[kingme23]

When looking at DENTIST average incomes, and comparing where you would like to be on that scale, consider that you are comparing yourself to people who have earned a dental degree. By definition, they possess (generally) a higher than average intellect, and have at least shown the work ethic to make it through undergrad with a high enough GPA to get INTO dental school (no small feat), and then make it THROUGH dental school.

So anyone thinking, "man no way will I have any problem doing 1.5 million a year solo practice!" is most likely setting themselves up for disappointment.

Think about it. If the average dentist GP practice does 700k, do you really think this is because the majority of dentist are lazy, clinically inept, or just bad businessmen?

Hardly. There are many smart, skilled, hardworking dentists out there giving 100% of their effort to collect that $700k.


I don't think it is possible, except in a very underserved area, to open an office and in a couple of years be bringing in $100k a month (collections, NOT "production", which based on how it is defined, can have little meaning relative to reality). I DO know guys who have done it, BUT ONLY IN UNDERSERVED RAPIDLY GROWING AREAS. Think Vegas 15-20 years ago. Texas oil country 10 years ago (not Dallas or Houston, think Midland or the areas around it. etc, etc. Not even sure what areas are "booming" for dentists now.


For the specialist who have shared on this thread, great info, but for those who are contemplating practice as a general dentist, recognize that their experience has little bearing on building or running a successful general dental office. Again - look at the medians/averages; specialists make twice, and often more than twice what general dentists make, and they simply do NOT have the competition that a general office has, nor do they spend their days doing small $ procedures. Doing those small $ procedures all day long, day in and day out, takes a toll on any dentist.

Yes.

The majority of people who got into dental school are very intelligent. But no amount of book smarts is going to teach you how to run a successful business and be successful. I’ll take it a step further and say that dentists are woefully ignorant when it comes to understanding business. Most of us spend our whole lives achieving academic excellence, and have not ever had to think about how a BUSINESS runs.

I can tell you from knowing enough people in the finance/insurance world, that dentists and doctors are laughing stocks in that realm. They laugh at how ignorant we are about money, and how gullible we are.

Lots of us chose dentistry over medicine because we were told the lifestyle is way more chill. By nature then, lots of docs don’t want to work insanely hard, especially the older ones. Lots of docs don’t care about money, as long as they have enough to support their family. Lots of docs want to have children and cut their hours down to a couple days per week. Lots of docs are perfectionists and can’t work fast enough to be highly profitable. Lots of docs can’t live anywhere except SoCal and so will accept a lower income.

I respect and am not trying to discredit you, but I hate when people refer to those salary surveys for dentists without any context behind it and claim that dentistry is doomed. They don’t tell the whole story.

 

[DDS9994]

Yes.

The majority of people who got into dental school are very intelligent. But no amount of book smarts is going to teach you how to run a successful business and be successful. I’ll take it a step further and say that dentists are woefully ignorant when it comes to understanding business. Most of us spend our whole lives achieving academic excellence, and have not ever had to think about how a BUSINESS runs.

I can tell you from knowing enough people in the finance/insurance world, that dentists and doctors are laughing stocks in that realm. They laugh at how ignorant we are about money, and how gullible we are.

Lots of us chose dentistry over medicine because we were told the lifestyle is way more chill. By nature then, lots of docs don’t want to work insanely hard, especially the older ones. Lots of docs don’t care about money, as long as they have enough to support their family. Lots of docs want to have children and cut their hours down to a couple days per week. Lots of docs are perfectionists and can’t work fast enough to be highly profitable. Lots of docs can’t live anywhere except SoCal and so will accept a lower income.

I respect and am not trying to discredit you, but I hate when people refer to those salary surveys for dentists without any context behind it and claim that dentistry is doomed. They don’t tell the whole story.

I don't think those guys giving the raw truth who are practicing day to day, are saying dentistry is doomed at all. Think about what you just said , the majority of those going into dental school have no business sense, and now you just graduated with about 500K in loans and have to learn about business on the fly, thats a huge burden to carry. The older Docs may not have to worry about money as they have no loans, but unless your school was paid for I don't see how new grads can't worry about money at all. I agree with you about the people in the finance world, I will tell you they never laugh at me, they actually can't stand people like me, you know why? because I never fall for the crap that they are peddling, and for the most part most of it is crap based on making commissions. I am not saying there are no good financial advisors but only a few, the majority are former salesman on their second or third careers who did a crash course thru Edward Jones, RayJames, etc or even worse Northwestern Mutual. Sadly most doctors think its a status symbol to say " my financial guy". at the country club.

 

[kingme23]

I don't think those guys giving the raw truth who are practicing day to day, are saying dentistry is doomed at all. Think about what you just said , the majority of those going into dental school have no business sense, and now you just graduated with about 500K in loans and have to learn about business on the fly, thats a huge burden to carry. The older Docs may not have to worry about money as they have no loans, but unless your school was paid for I don't see how new grads can't worry about money at all. I agree with you about the people in the finance world, I will tell you they never laugh at me, they actually can't stand people like me, you know why? because I never fall for the crap that they are peddling, and for the most part most of it is crap based on making commissions. I am not saying there are no good financial advisors but only a few, the majority are former salesman on their second or third careers who did a crash course thru Edward Jones, RayJames, etc or even worse Northwestern Mutual. Sadly most doctors think its a status symbol to say " my financial guy". at the country club.

I agree with you, although the 500K in debt is a very recent phenomena. The average dental student loan debt is still well below 300K, which is still a tough go but easier to swallow than 500K.

 

[DDS9994]

I agree with you, although the 500K in debt is a very recent phenomena. The average dental student loan debt is still well below 300K, which is still a tough go but easier to swallow than 500K.

True but more and more of these new school as well as other schools are raising tuition literally every year and some places close to double digits, not a good trend.

 

[2TH MVR]

With all the doom and gloom posts (I'm sure I've contributed to some of them). Are there any practicing dentists/specialists that see a positive in today's economy? Any aspect of practicing dentistry that is easier now than it was 20 years ago?

 

[Big Time Hoosier]

Any aspect of practicing dentistry that is easier now than it was 20 years ago?

Yes, thanks to the Isolite!

Big Hoss

 

[charlestweed]

With all the doom and gloom posts (I'm sure I've contributed to some of them). Are there any practicing dentists/specialists that see a positive in today's economy? Any aspect of practicing dentistry that is easier now than it was 20 years ago?

Rapid population growth here in CA has helped a lot. Hispanic families have more kids than the average... and they tend to get married and have kids at younger age. There is also a significant increase in immigrations from countries like China and Vietnam in recent years. Many of my young Asian patients don't speak English fluently and this tells me that they came here very recently.

Ortho/ dental supplies are getting cheaper. When I started my first office years ago, I had to buy expensive brackets and wires through the sale reps from companies like GAC, Unitek, Ormco etc. Now there are plenty of cheap brackets that can be purchased online directly. Before, I had to use expensive Midwest handpieces and they required repairs very often. Now, I can buy cheap $12 Ebay handpieces that last longer than the Midwest ones. One thing about ortho is you don't need fancy brackets, wires and other fancy stuff in order to produce good clinical results. Good ortho results depend solely on the doctor's clinical skills.

 

[dentistspec123]

I agree with you, although the 500K in debt is a very recent phenomena. The average dental student loan debt is still well below 300K, which is still a tough go but easier to swallow than 500K.

"According to the American Dental Education Association (ADEA), the average debt per graduating senior is $287,331 (according to a 2017 survey)."

287,331 is not "well below 300k." The debt phenomena is more common than you think. The numbers are skewed in my opinion because most people going to dental school are either in one or two categories: full tuition loan borrowers or those with close to or no loans (familial help, those from wealthier means). The disparities this could create in dentistry as well is another topic though.

 

[Big Time Hoosier]

The numbers are skewed in my opinion because most people going to dental school are either in one or two categories: full tuition loan borrowers or those with close to or no loans (familial help, those from wealthier means).

This. Some schools may have upwards of 10-15% on the military's HPSP. Who knows what percent have partial or total familial support.

Big Hoss

 

[kingme23]

"According to the American Dental Education Association (ADEA), the average debt per graduating senior is $287,331 (according to a 2017 survey)."

287,331 is not "well below 300k." The debt phenomena is more common than you think. The numbers are skewed in my opinion because most people going to dental school are either in one or two categories: full tuition loan borrowers or those with close to or no loans (familial help, those from wealthier means). The disparities this could create in dentistry as well is another topic though.

Also the fact that not everyone going to DS these days is going to a private school. Last I checked, most state schools are under 300K in tuition. While the 500K is becoming more common, I would hesitate to call that “normal” at this point in time.

 

[dentistspec123]

Also the fact that not everyone going to DS these days is going to a private school. Last I checked, most state schools are under 300K in tuition. While the 500K is becoming more common, I would hesitate to call that “normal” at this point in time.

For sure, 500k in loans is not normal, but it definitely is becoming more common. Moreover, most state schools at this point are coming very close to or have surpassed 300k for 4 years as well, look at UCLA, UCSF, Uni of Florida, Buffalo, Stony Brook, Maryland, VCU etc etc (sure there are cheap schools in texas and the south but I am talking from my familiarity living on the east/west coasts). This is not to mention the interest accrued for dental students at a 6.8% interest rate and increasing tuition every year...so that price tag on paper of 70,000 (avg of the schools I mentioned) a year for a state school (280,000 for four years) really is over 300,000 after all is said and done.

 

[TanMan]

With all the doom and gloom posts (I'm sure I've contributed to some of them). Are there any practicing dentists/specialists that see a positive in today's economy? Any aspect of practicing dentistry that is easier now than it was 20 years ago?

I think it's harder to produce money now from each procedure now than it was before. I haven't been practicing for long, but the technologies that I feel are game changers (for GP's) are pretty much reciprocating endodontic files and CEREC. From those two technologies, single visit single tooth specialists are born. It's possible to do RCTBUCrown in 30 mins of doctor chairtime for 1300-2500 with minimal overhead.

Another aspect of dentistry that I feel is a game changer is flapless single tooth implant restoration. CT/Digital scanning pretty much puts predictable implant placement at 10-15 mins of doctor chairtime (when there's enough bone). If it requires more time, should probably refer those out. (Edit: Total time can be 10-15 mins if you outsource your treatment planning and surgical guide fabrication. If you're busy enough that you don't have the time, it's better to outsource since your time is more valuable. If you have plenty of time, save yourself the money and treatment plan/fabricate the guide yourself)

Digital radiography / portable xrays are another major improvement. No more chemicals, instant images. Also, you are able to detect caries and other pathology a lot more readily.

I think technology makes our offices more productive, but we have to see more patients to make the same amount as our predecessors (inflation adjusted). When evaluating technology, I always ask, what's my ROI on this product and how can I bill for it? If your salesperson cannot answer that question directly, steer clear. Even if they can answer that question, it's best to do your research and see whether it can fit into your workflow and business model.

 

[2TH MVR]

I think it's harder to produce money now from each procedure now than it was before. I haven't been practicing for long, but the technologies that I feel are game changers (for GP's) are pretty much reciprocating endodontic files and CEREC. From those two technologies, single visit single tooth specialists are born. It's possible to do RCTBUCrown in 30 mins of doctor chairtime for 1300-2500 with minimal overhead.

Another aspect of dentistry that I feel is a game changer is flapless single tooth implant restoration. CT/Digital scanning pretty much puts predictable implant placement at 10-15 mins of doctor chairtime (when there's enough bone). If it requires more time, should probably refer those out. (Edit: Total time can be 10-15 mins if you outsource your treatment planning and surgical guide fabrication. If you're busy enough that you don't have the time, it's better to outsource since your time is more valuable. If you have plenty of time, save yourself the money and treatment plan/fabricate the guide yourself)

Digital radiography / portable xrays are another major improvement. No more chemicals, instant images. Also, you are able to detect caries and other pathology a lot more readily.

I think technology makes our offices more productive, but we have to see more patients to make the same amount as our predecessors (inflation adjusted). When evaluating technology, I always ask, what's my ROI on this product and how can I bill for it? If your salesperson cannot answer that question directly, steer clear. Even if they can answer that question, it's best to do your research and see whether it can fit into your workflow and business model.

I agree with everything you have said. But as I see it .... technology has mostly benefited GPs more so than specialists. Tech has made it easier for GPs to do advanced procedures that at one time were mostly done by specialists. Difficult RCT. Single tooth implants. Invisalign. CAD CAM eliminating the need for labs. New pharmacology to help with perio disease. Etc. Etc.

So, tech in the last 20 years has given GPs more tools to use and to expand their scope of treatment. That's a POSITIVE for GPs over the GPs 20 years ago.

 

[DDS9994]

I think it's harder to produce money now from each procedure now than it was before. I haven't been practicing for long, but the technologies that I feel are game changers (for GP's) are pretty much reciprocating endodontic files and CEREC. From those two technologies, single visit single tooth specialists are born. It's possible to do RCTBUCrown in 30 mins of doctor chairtime for 1300-2500 with minimal overhead.

Another aspect of dentistry that I feel is a game changer is flapless single tooth implant restoration. CT/Digital scanning pretty much puts predictable implant placement at 10-15 mins of doctor chairtime (when there's enough bone). If it requires more time, should probably refer those out. (Edit: Total time can be 10-15 mins if you outsource your treatment planning and surgical guide fabrication. If you're busy enough that you don't have the time, it's better to outsource since your time is more valuable. If you have plenty of time, save yourself the money and treatment plan/fabricate the guide yourself)

Digital radiography / portable xrays are another major improvement. No more chemicals, instant images. Also, you are able to detect caries and other pathology a lot more readily.

I think technology makes our offices more productive, but we have to see more patients to make the same amount as our predecessors (inflation adjusted). When evaluating technology, I always ask, what's my ROI on this product and how can I bill for it? If your salesperson cannot answer that question directly, steer clear. Even if they can answer that question, it's best to do your research and see whether it can fit into your workflow and business model.

I agree with most of what you said. The only place I Disagree with you is with CEREC. I just don't see the big savings with it. Nowadays my lab can crank out a great fitting zirconia crown with minimal adjustment for 79 bucks and no its not made in China its made 15 minutes from my office in Illinois. The CAD CAM has also benefited labs so that they can make crowns even cheaper. CEREC is an ongoing expense despite what they tell you, hand over 120K and no you are never done spending, new burs, warranties, upgrades etc. I have yet to have a pt complain about coming back for a second appointment that takes maybe 10 minutes. ITs a solution to a problem I don't have. And lastly be careful about marketing name brands in your practice and not services, it has a deleterious effect in the long run on the profession. Think Invisilign.

 

[TanMan]

I agree with most of what you said. The only place I Disagree with you is with CEREC. I just don't see the big savings with it. Nowadays my lab can crank out a great fitting zirconia crown with minimal adjustment for 79 bucks and no its not made in China its made 15 minutes from my office in Illinois. The CAD CAM has also benefited labs so that they can make crowns even cheaper. CEREC is an ongoing expense despite what they tell you, hand over 120K and no you are never done spending, new burs, warranties, upgrades etc. I have yet to have a pt complain about coming back for a second appointment that takes maybe 10 minutes. ITs a solution to a problem I don't have. And lastly be careful about marketing name brands in your practice and not services, it has a deleterious effect in the long run on the profession. Think Invisilign.

The CEREC system (or digital impression system) works if you have sufficient volume of fixed restorations in your office. The hard cost savings are definitely not as big as the manufacturer wants you to think; however, the savings in time is much more important than the hard costs in savings. CEREC/Digital impressions saves you time in terms of impression materials, trays, shipping costs, turnaround time (for certain things), and for implant restorations, it's amazing. Take the healing abutments off, throw in the scanning abutments, scan, replace w/ healing abutment again, 1-2 weeks later, abutment/crown... or if you're doing encode abutments with 3i, just scan the damn thing and wait for your abutment/crown to come in. No analogs, open/closed tray, etc... There is definitely upkeep to the CEREC system, there's consumables and warranty that definitely need to be considered. I have enough c&b that I guess you can say I "wasted" my money on 2 systems (CEREC/3shape), but I have enough chairs that I can just keep jumping from room to room to prep,exam,rct, or other stuff and come back when my crowns are baked and complete already. 2nd appt? No thanks, my CEREC broke down for a few days and it felt like a SHTF situation when I had to see the patient another day to cement the crown. That backlog was just awful, and I can see that having a same day crown solution definitely saves time to allow you to see more c&b patients. We only do about 50-60 CEREC crowns per month at this time, and they come in waves. I don't do CEREC bridges, multi-unit anteriors, or more than 2 crowns at a time on CEREC because it takes quite a bit longer and I can send those to a lab via digital impression, but for single units, CEREC is king. A digital impression is great for most things except complete dentures (which I do not do anymore). I think when we look at our ROI on an investment, we should also look at the opportunity costs associated with the time savings of a product. Is it worth 120k? Only if you have enough patients that you need all the time you can get to fit in more patients; then your time is worth more than the initial and recurring costs. If you have plenty of time in your office or have a relatively low volume of crowns, then do it the traditional way.

Marketing name brands work if the name brand has a large brand name recognition that people want and ask for by name. I don't do invisalign, but I have plenty of patients that definitely ask for it by name.

 

[DDS9994]

The CEREC system (or digital impression system) works if you have sufficient volume of fixed restorations in your office. The hard cost savings are definitely not as big as the manufacturer wants you to think; however, the savings in time is much more important than the hard costs in savings. CEREC/Digital impressions saves you time in terms of impression materials, trays, shipping costs, turnaround time (for certain things), and for implant restorations, it's amazing. Take the healing abutments off, throw in the scanning abutments, scan, replace w/ healing abutment again, 1-2 weeks later, abutment/crown... or if you're doing encode abutments with 3i, just scan the damn thing and wait for your abutment/crown to come in. No analogs, open/closed tray, etc... There is definitely upkeep to the CEREC system, there's consumables and warranty that definitely need to be considered. I have enough c&b that I guess you can say I "wasted" my money on 2 systems (CEREC/3shape), but I have enough chairs that I can just keep jumping from room to room to prep,exam,rct, or other stuff and come back when my crowns are baked and complete already. 2nd appt? No thanks, my CEREC broke down for a few days and it felt like a SHTF situation when I had to see the patient another day to cement the crown. That backlog was just awful, and I can see that having a same day crown solution definitely saves time to allow you to see more c&b patients. We only do about 50-60 CEREC crowns per month at this time, and they come in waves. I don't do CEREC bridges, multi-unit anteriors, or more than 2 crowns at a time on CEREC because it takes quite a bit longer and I can send those to a lab via digital impression, but for single units, CEREC is king. A digital impression is great for most things except complete dentures (which I do not do anymore). I think when we look at our ROI on an investment, we should also look at the opportunity costs associated with the time savings of a product. Is it worth 120k? Only if you have enough patients that you need all the time you can get to fit in more patients; then your time is worth more than the initial and recurring costs. If you have plenty of time in your office or have a relatively low volume of crowns, then do it the traditional way.

Marketing name brands work if the name brand has a large brand name recognition that people want and ask for by name. I don't do invisalign, but I have plenty of patients that definitely ask for it by name.

Sounds like its working for you thats good, for me the volume just isn't there, and trays, cheap housebrand impressions materials, and a great lab which can turn around in 7 days no biggie. Sounds like you have to train your assistants on the scanning I assume to help out. The marketing comment I referred to has more to do with we are in a time where these manufacturers use us to get the word out as well and endorse their products then turnaround and attempt to bypass the traditional doctor/patient relationship, ala Smile Direct. Who knows if that will happen with CEREC, but I never thought back in 1999 in dental school there would be do it yourself braces..

 

[2TH MVR]

CEREC system still needs a dentist to prep the tooth. No prep needed with all the aligner systems. Although a scan could be made of a patient's anterior teeth and "'no-prep" veneers could be fabricated. Patient picks a shade, shape of veneers. Viola ..... slip on veneers. Actually sounds like an interesting business venture. Right up there with Smile Direct.

 

[hellopeople]

In your honest opinion, is it worth it to pursue dentistry even if the tuition is around 400-500k? I was wondering if recent grads and current dentists could give their inputs, as the debt in this day and age does seem daunting and I’d like to be informed. I assume that after your repayment term, things become less difficult? Thank you!

Not if you're paying the tuition.
The numbers quoted in this thread are so far from realistic. Thinking you're going to be making way more than 150k or "200k easy" is naive. (Although the oral surgeon income mentioned above is actually quite low.)