Is it worth it to pursue dentistry nowadays?

[setdoc7]

TanMan. If you are no longer doing CUD/CLD, then how are you doing hybrid cases? Something I do a lot of in my office, and have been using digital impressions for. Not everyone is a candidate for "teeth in a day".

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[setdoc7]

I'm in reasonably good physical shape, have a lot of experience doing a wide variety of procedures, and do not get mentally tired easily. With that said, running 4 operatories simultaneously sounds almost impossible, especially when doing extensive cases. Prepping 4 or 5 teeth for crowns takes time even for the experienced operator, and is not a job you can hand off to an assistant. What happens to the other 3 patients?
What is the difference if they are in a chair or in the waiting room? And what about talking to patients about upcoming extensive rehabilitation treatment? It is unethical to not fully explain to the patient what the entire treatment plan is, how long it is expected to take, and what type of outcome they can expect.....so that the patient understands. And when do you put all of this into the chart? It all takes time.
Chart audits are real. Take time to document.

 

[beannaithe]

Dentistry isn't worth $500k. Never has been. Never will be. If someone else pays for it or you can go for less than $200k, it's a great job with wonderful earning potential. But as the corps take over, it is getting harder and hard to eke out a living as a gp. It's nearly impossible to find a decent or even semi-decent practice. The corps gobble up nearly everything that has even a hint of potential for full or over-market value. Insurance companies drive reimbursement rates down, so pay is going down. Honestly, it's just not as easy as it used to be.

I started out with $300k in student loans and was on track to pay it off in 5 years. Throw in some health issues and a kid (daycare!) and I'm on track for it to be gone in 10. The lifestyle is great. I work part-time and bring home 6 figures (but it's not easy money. I run 2 rooms and check 4 hygienists). But a huge chunk goes to living expenses and student loans. Keep in mind that the mental drag of watching a good chunk of your money go out the door is exhausting. I see friends who got bachelor's in engineering and computer stuff upgrading their starter houses and Mercedes while we can't afford a house yet due to the amount of debt.

Another thing to remember too is that the job is itself stressful. You have to always be "on" at the office. Even if you're having a bad day, people expect you to be happy and upbeat because a lot of them are scared. It's not uncommon to have to switch from talking to someone about losing a parent to being goofy while counting a 4 year old's teeth to trying to connect with an elderly patient who is lonely to joking with a regular again. That could all be in the span of 5 minutes. Then, you need to go back to making sure you're nailed your crown margins or that your composite is sealed. You also have to deal with the anxiety and fear before you stick a needle in someone's face multiple times a day. It's mentally and physically exhausting. Add to that trying to pay off $500k in debt with very little tangible reward is a perfect recipe for burn out.

Don't underestimate that level of debt because it's like a dead weight until you pay it off.

I think I'm just extra salty tonight because it's my weekend on call and I've had 4 pages since I left work 8 hours ago. Unfortunately, dentistry is not a job you leave at work.

 

[TanMan]

TanMan. If you are no longer doing CUD/CLD, then how are you doing hybrid cases? Something I do a lot of in my office, and have been using digital impressions for. Not everyone is a candidate for "teeth in a day".

Now, I avoid full mouth restorations/prosthetisis or anything of that sort. I send my patients out to a dentist that will do anything from CUD/CLD or partials, all the way to all on X's. Not things I want to do, nor have the patience or passion to do. Lab costs are very high for full arch implant restorations and time spent planning and executing is not as profitable for me as rctbucrown.

I'm in reasonably good physical shape, have a lot of experience doing a wide variety of procedures, and do not get mentally tired easily. With that said, running 4 operatories simultaneously sounds almost impossible, especially when doing extensive cases. Prepping 4 or 5 teeth for crowns takes time even for the experienced operator, and is not a job you can hand off to an assistant. What happens to the other 3 patients?
What is the difference if they are in a chair or in the waiting room? And what about talking to patients about upcoming extensive rehabilitation treatment? It is unethical to not fully explain to the patient what the entire treatment plan is, how long it is expected to take, and what type of outcome they can expect.....so that the patient understands. And when do you put all of this into the chart? It all takes time.
Chart audits are real. Take time to document.

With the 3 other patients, they wait while you're finishing the other treatment. FIFO - First in, first out, unless one of them is a bottleneck/time consuming procedure. They they go last in the cycle. Interesting part is my procedural time is actually faster than the wait time. In an hour long appt, they could wait 50 mins, I'll finish in 10 mins, and they'll still thank me for making the procedure quick and easy. I try and accommodate patients who are in pain and those are the ones who are usually the most patient (because no one else would see them the same day!) They can wait 2 hours before being treated and they will still thank you for seeing them when everyone else is closed.

Chair v. Waiting room. If they are in a waiting room for too long, they perceive that they might be ignored. Once they are placed in a chair (if they are a solo patient), then the clock tends to slow down in their perception. Waiting in a chair is better than waiting in the waiting room.

From the first response, I avoid full mouth rehabs like the plague. If they need a rehab, and I anticipate it's not worth my time, I'll man up and say that I don't do extensive rehabs and it would be a disservice for me to do so. They usually respect that and take the referral. I explain everything one time, if they need me to clarify something, I'll answer it then and there. If they need clarification after the end of the visit when I've left the room, my assistants will go over it again. Also good to ask the patient in the treatment room if they know what we are doing today. If they are uncertain about going through with it, I'll let them know to let me know when they are ready or they can always get a second opinion. I have autonotes that put most of that information in for me already.

I've been audited several times already. They haven't clawed for their money back yet.

 

[TanMan]

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

I forgot about your post, but I think an extraction/denture mill FFS style practice would work really well if you follow this office's model (it's a legit dental office, not a pr0n site, despite the name):

Sexton Dental Clinic

These guys are probably king of low end FFS services. Lines out the door at 5 or 6am and if they don't like it, they can GTFO. Low low FFS prices, no insurances, and I think you can definitely produce 2M+ with this model of FFS. You'll probably have to see a massive volume to make that amount, but it's a big market. If I wanted to do a 100% FFS practice, this would probably be the way to go if I didn't care about reputation or people (you are treated as a number). I love the sign that some patient posted of the office!

 

[setdoc7]

Now, I avoid full mouth restorations/prosthetisis or anything of that sort. I send my patients out to a dentist that will do anything from CUD/CLD or partials, all the way to all on X's. Not things I want to do, nor have the patience or passion to do. Lab costs are very high for full arch implant restorations and time spent planning and executing is not as profitable for me as rctbucrown.



With the 3 other patients, they wait while you're finishing the other treatment. FIFO - First in, first out, unless one of them is a bottleneck/time consuming procedure. They they go last in the cycle. Interesting part is my procedural time is actually faster than the wait time. In an hour long appt, they could wait 50 mins, I'll finish in 10 mins, and they'll still thank me for making the procedure quick and easy. I try and accommodate patients who are in pain and those are the ones who are usually the most patient (because no one else would see them the same day!) They can wait 2 hours before being treated and they will still thank you for seeing them when everyone else is closed.

Chair v. Waiting room. If they are in a waiting room for too long, they perceive that they might be ignored. Once they are placed in a chair (if they are a solo patient), then the clock tends to slow down in their perception. Waiting in a chair is better than waiting in the waiting room.

From the first response, I avoid full mouth rehabs like the plague. If they need a rehab, and I anticipate it's not worth my time, I'll man up and say that I don't do extensive rehabs and it would be a disservice for me to do so. They usually respect that and take the referral. I explain everything one time, if they need me to clarify something, I'll answer it then and there. If they need clarification after the end of the visit when I've left the room, my assistants will go over it again. Also good to ask the patient in the treatment room if they know what we are doing today. If they are uncertain about going through with it, I'll let them know to let me know when they are ready or they can always get a second opinion. I have autonotes that put most of that information in for me already.

I've been audited several times already. They haven't clawed for their money back yet.

Okay, so no full arch, but molar endo and multiple crown preps take time. No one does any of this in 10 minutes. That’s all I’m saying. I have auto notes, but an initial exam takes chair time as well. All I am trying to bring up is some of your posts over simplified the actual day to day work. Unless you are only doing simple procedures. Not high paying work.
Btw, implant placement is more complex than u are making it sound. Punch holes hide bone defects and without a CT u are essentially blind. Second stage grafting takes time as well.

 

[Shunwei]

Okay, so no full arch, but molar endo and multiple crown preps take time. No one does any of this in 10 minutes. That’s all I’m saying. I have auto notes, but an initial exam takes chair time as well. All I am trying to bring up is some of your posts over simplified the actual day to day work. Unless you are only doing simple procedures. Not high paying work.
Btw, implant placement is more complex than u are making it sound. Punch holes hide bone defects and without a CT u are essentially blind. Second stage grafting takes time as well.

That’s why his posts are really dangerous sand misleading. Even assuming what he claims is true (and there are a lot of BS even on dentaltown), he is a far, far outlier from reality.

For every successful putative Tanman there are many dozens of other dentists who are just scraping to get by. I know of many offices NOT doing well.

Sad thing is, the predents on here will definitely gravitate towards his posts because that’s all they want to hear at this time.

Truth is, only a portion of the new dentists every year will be truly successful. But at this point predents always think they will be the ones. Kind of like how in surveys 90-95% of people think they are above average. That kind of thing.

Like I said before, Endoaccess had the best post in here. That post really should be stickied.

 

[deleted659902]

That’s why his posts are really dangerous sand misleading. Even assuming what he claims is true (and there are a lot of BS even on dentaltown), he is a far, far outlier from reality.

For every successful putative Tanman there are many dozens of other dentists who are just scraping to get by. I know of many offices NOT doing well.

Sad thing is, the predents on here will definitely gravitate towards his posts because that’s all they want to hear at this time.

Truth is, only a portion of the new dentists every year will be truly successful. But at this point predents always think they will be the ones. Kind of like how in surveys 90-95% of people think they are above average. That kind of thing.

Like I said before, Endoaccess had the best post in here. That post really should be stickied.

Shunwei, I'm assuming you are a practice owner. A couple of questions for you...

1) is it a single doc office, and how many hygienists do you employ?
2) annual production and overhead %?
3) do you provide specialist procedures in addition to restorative work?
4) do you accept medicaid/medicare and/or HMO/PPO? if so, ratio of insurance to FFS?
5) is your practice situated in a major city (defined as pop. of 200k-300k+)?
6) working hours/week?

 

[ysrebob]

I have been reluctant to say anything at all because it's hard to not come across as suspicious or judgemental or negative or etc.

But Tanman IMO your ability to complete molar RCT / core / crown in 45 minutes of total doctor time is so far from what a typical dentist can expect to achieve as to be misleading to hold out as an example. Even more so, your ability to simultantously run four columns of your own patients plus 3 or 4 columns of hygiene recalls is so far from what a typical dentist can expect to achieve as to be grossly misleading. I know if I tried to do that my quality of care would be awful. You sound serious about quality of care in your posts re RCT procedures so I have to assume you are just in the top .0001% clinically. Every field of endeavor has exceptional talents. No combination of will, desire, and work ethic will make most of us like them. For the average predent or student to plan to replicate your results is kind of like trying to replicate Tiger Woods at his peak in golf or something: NOT A REASONABLE EXPECTATION. Personally producing general dentistry in the volumes you are talking about, Tanman, while maintaining acceptable clinical quality, for most mere mortals cannot be done. IMHO any would-be-dentist who hopes to do it is deluding themselves, and should not dismiss the weight of taking on too much student debt based on your extremely atypical experience.

Despite having done a startup myself (and through a combination of luck/location/preparation done well with it), I would side with Rainee that for most people buying a successful existing office is BY FAR the best plan. And taking on too much student debt to enable ever escaping associateships to buy a good office is a very bad plan.

 

[Shunwei]

I have been reluctant to say anything at all because it's hard to not come across as suspicious or judgemental or negative or etc.

But Tanman IMO your ability to complete molar RCT / core / crown in 45 minutes of total doctor time is so far from what a typical dentist can expect to achieve as to be misleading to hold out as an example. Even more so, your ability to simultantously run four columns of your own patients plus 3 or 4 columns of hygiene recalls is so far from what a typical dentist can expect to achieve as to be grossly misleading. I know if I tried to do that my quality of care would be awful. You sound serious about quality of care in your posts re RCT procedures so I have to assume you are just in the top .0001% clinically. Every field of endeavor has exceptional talents. No combination of will, desire, and work ethic will make most of us like them. For the average predent or student to plan to replicate your results is kind of like trying to replicate Tiger Woods at his peak in golf or something: NOT A REASONABLE EXPECTATION. Personally producing general dentistry in the volumes you are talking about, Tanman, while maintaining acceptable clinical quality, for most mere mortals cannot be done. IMHO any would-be-dentist who hopes to do it is deluding themselves, and should not dismiss the weight of taking on too much student debt based on your extremely atypical experience.

Despite having done a startup myself (and through a combination of luck/location/preparation done well with it), I would side with Rainee that for most people buying a successful existing office is BY FAR the best plan. And taking on too much student debt to enable ever escaping associateships to buy a good office is a very bad plan.

I consider myself pretty fast and efficient and good at running multiple chairs. But there is absolutely no way in hell i can run 4 dentist chairs plus 4 hygiene recall chairs. I honestly think there is no way either given that even for hygiene recall you’d want to greet the patient, take a good hard and soft tissue look, and examine the radiographs and go over any questions the hygienist/patient may have. That alone for each patient should take about 10 minutes of dentist chair time for a quality exam.

As for a 45 min molar rct/bu/crown, that’s also extremely suspect. Any competent dentist should know that the key to a good molar (or any) Endo is to find all canals, do thorough debridement, rinse repeatedly and thoroughly, and get a good fill. The buildup also has to be done incrementally to minimized the c factor and also ensure a good seal. The crown might be the easiest part but in certain mouths where opening is limited and tongue is in the way it can also be hard. The disinfection process alone should take at least15 minutes for the hypochlorite to soak and disinfect. An Endo activator can assist but time duration is still a critical factor.

This guy Tanman if I recall has actually shown photos of his putative cars. I am firmly in the camp of the Millionaire Next Door philosophy. The truly wealthy don’t flaunt their wealth and it’s the stealth wealth guys that have the real money. JMHO.

 

[TanMan]

Okay, so no full arch, but molar endo and multiple crown preps take time. No one does any of this in 10 minutes. That’s all I’m saying. I have auto notes, but an initial exam takes chair time as well. All I am trying to bring up is some of your posts over simplified the actual day to day work. Unless you are only doing simple procedures. Not high paying work.
Btw, implant placement is more complex than u are making it sound. Punch holes hide bone defects and without a CT u are essentially blind. Second stage grafting takes time as well.

That is true, mostly fills, extractions, single unit crowns are 5-10 mins. That was just an example of a 1 hour time slot; for RCT's and other longer procedures, those time slots can take 1 column, 2-3 hours depending on how many are back to back. This isn't easy work.

Implant placement can go from slam dunk all the way to WTF just happened. It's not always easy. I advocate GP's to do the easy ones and send the hard ones to the surgeons (no bone, sinus lifts, problematic medical histories, etc...) I'd agree that a CT is always prudent, even for a single unit, to identify any aberrant anatomy or defects. We do almost all of our implants guided and flapless whenever possible. Only time that I don't use guided is for immediate placement since the remaining bone will dictate my primary stability or whether I'll have to abort, graft, and see them in a few months. I'll still take a CT pre-op.

I consider myself pretty fast and efficient and good at running multiple chairs. But there is absolutely no way in hell i can run 4 dentist chairs plus 4 hygiene recall chairs. I honestly think there is no way either given that even for hygiene recall you’d want to greet the patient, take a good hard and soft tissue look, and examine the radiographs and go over any questions the hygienist/patient may have. That alone for each patient should take about 10 minutes of dentist chair time for a quality exam.

As for a 45 min molar rct/bu/crown, that’s also extremely suspect. Any competent dentist should know that the key to a good molar (or any) Endo is to find all canals, do thorough debridement, rinse repeatedly and thoroughly, and get a good fill. The buildup also has to be done incrementally to minimized the c factor and also ensure a good seal. The crown might be the easiest part but in certain mouths where opening is limited and tongue is in the way it can also be hard. The disinfection process alone should take at least15 minutes for the hypochlorite to soak and disinfect. An Endo activator can assist but time duration is still a critical factor.

This guy Tanman if I recall has actually shown photos of his putative cars. I am firmly in the camp of the Millionaire Next Door philosophy. The truly wealthy don’t flaunt their wealth and it’s the stealth wealth guys that have the real money. JMHO.

If you've done enough endos, you eventually get proficient at reading the pulpal floor and doing it mostly by feel. I find that finding the canals is not the hard part, the hardest part is getting good isolation when you got multiple walls broken down and you have to place a sub-G buildup before placing that rubber dam. You typically get a lot of bleeding, and you have to work really fast or else you're going to get stuck managing hemostasis for awhile.

I used to use the endoactivator, which is awesome for anteriors, but I use an Er:Yag laser to do PIPS and that really cleans the canals and gets at the lateral canals when present. There's a few ways I speed up the disinfection process.. heated 8.25% NaOCl (heat + conc speeds up disinfection), simultaneous irrigation and instrumentation with hypo (more contact time while cleaning organic/inorganic debris), QMix at the end (EDTA/CHX, single step). Have I ever had a bleach accident? Nope. Are my endos perfect 100% of the time? Nope. However, it's bad business if they fail, but we're not a machine shop with 100% predictability. We want to achieve perfection, but the mouth is a continually changing and dynamic environment. Dental school will have you believe that everything should last forever and if you follow their steps, it will. In reality, things happen and from a business perspective, you gotta do things fast and well. Otherwise, you'll have a lot of failures that will clog up your system over time.

These implications that there's no other way to do it but a certain way (when it comes to clinical or business) is also a dangerous line of thinking. If you cannot think outside the box or innovate, you will be left behind or remain stagnant. As clinicians, we should always think about what we're doing, why we're doing it, AND how we can improve upon it. I think we tend to forget about the last part.

On the "millionaire next door" philosophy, I used to believe that because it made me feel good about saving up every last penny I had. When I think about it more, there's a few aspects that made me rethink my position, but also think about why people believed in the unassuming millionaire next door. To have wealth and material things are two separate but connected aspects of the true wealth of an individual. A person can go out and buy or lease all the nice things that they want, but they aren't wealthy because it's all a show. That's why during income tax refund season, I see a lot more 3 series bimmers that are typically leases out on the road. On the flipside, you could have a next door neighbor that drives a Yugo but has millions from their frugal lifestyle. These are the two extremes and I think that philosophy makes us feel bad about our consumerism and rethink about wealth accumulation. However, as dentists, we are in a unique position that we earn more than most people. We will hit a limit at some point where we have enough wealth that it's redundant to keep saving all of it and trying to be as frugal as possible. What's the difference in the lifestyle of 10MM v. 100MM? Not enough for me to keep busting my ass and see my youthful years go away. When the years of my youth are gone and I have a massive pile of cash and wealth, can I carry that to any supposed afterlife? Am I going to give that to my kids, donate it to charity, or academic institution? Enjoy life while you're still young, I used to think I wanted to die working. My father was like that, and he got sick. It's these life changing moments that change your perspective on life. I'm only spending money that I can afford to spend/lose nor am I overextending myself to live a lifestyle I cannot afford. However, if you have the money to live a nice lifestyle, why not? Besides, my car is a practical car... very good gas mileage, safe to drive, and I can haul toilet paper and paper towels from Costco, haha.

Also, I think there's an inverse distribution and you might just be seeing part of the curve on the idea of wealthy. There's those silent millionaires, but those aren't the truly truly wealthy. However, I cannot generalize that the extremely wealthy are all flashy either, you'll have your mix of both, but those that have their wealth in the 8 figures (haven't met 9+ figure people that I know of yet) tend to have the nicer things in life.

TL;DR: Save up, but enjoy life while you're still young. Spend what you can afford.

PS: Another expensive hobby, guns! God, I love Texas

 

[setdoc7]

Btw Tanman, it takes me at least 10 minutes to anesthetize a patient, get consent, and gown up for even a simple extraction . I could not work in your office, or jam local into a patient .

 

[TanMan]

Anesthetic takes a minute (using prilo/septo combo most of the time). Most patients don't feel prilo for infiltrations, septo to seal the deal, and the topical gel helps quite a bit. Lower block is a different story. I step out to let it take into effect while I'm doing other things (procedures, more anesthetic, exams, etc...) There's written consent that my assistants obtain, verbal consent that I ask before we start, do you have any questions about what we're doing today? The patient knows why we're there and most do not have any questions. Most common is: can I eat afterwards or if it's friday or saturday, can I drink? Answers are usually yes, just don't bite your lip or yes, but don't mix it with pain meds or don't get too wasted. I let them know, we'll be doing this and this and we'll be done in about x mins, if you feel any pain, raise your left hand. I'm not sure what part take 10 minutes. I don't numb up and wait there for it to take into effect, I'll do something else if I have to. If there's absolutely nothing at all, I'll either step out and do some notes, do some admin stuff, review radiographs for the next exams, etc... That's how I can usually do an exam faster, if I had any downtime to review xrays/photos, I already know going into the exam and have done some of the treatment planning while reviewing the radiographs. One example of good gap time is when you need to take a length PA for an endo. I'll ask them to take a PA, while waiting, I'll go review a patient's radiographs and start tx planning or if I have a lot of hygiene waiting, maybe knock out an exam.

One of the keys of seeing many patients is having full awareness of your queue in the office.

Edit: I think if I had an associate who would take 10 mins to numb a patient/put on PPE, I would go crazy, unless they could take the tooth out in a min with no pain.

 

[charlestweed]

When you can't work as fast or see as many patients as other dentists, you can't just assume that those dentists do worse dentistry than yours. If their work were bad and there were lots of redos, no patient would come and they wouldn't have a busy successful office. Some dentists have better clinical and chairtime management skills than others. I think what Taman described was the "doctor's time" spent on each patient....and not the overall procedural time. It's not unreasonable to prep a tooth in 10 minutes. Spending more time may make things worse....ie overtappering or over reduction of tooth structure. There are assistants with extended function (RDAEF) who can pack cords, take impression, make and deliver temp crowns for the dentist.

Having a lot of chairs is key. When I set up my office, I told the contractor to give me as many chairs as possible. I don't need a doctor's private office nor a staff lounge. I come to work hard and not to sit around waiting for patients to come. It's actually stressful not to have a busy schedule. That's why I book as many patients in 1 day as possible and use the free days in a month to work for corp office.

 

[2TH MVR]

I have to hand it to @TanMan. He's being questioned for his posts and his responses are eloquent and non-personal. Well done.

 

[deleted659902]

I have to hand it to @TanMan. He's being questioned for his posts and his responses are eloquent and non-personal. Well done.

lol agreed;it's like watching a deposition. I also find it amusing that it's all fellow GPs that are questioning him (especially for endo work), not specialists.

If I recall correctly, TanMan posted that his office produced 2.5M+ in a year as a single doc office in less than five years out of dental school. Pretty impressive, particularly for a GP without a formal post-grad training like GPR/AEGD.

Regarding "truly wealthy don't show off" philosophy, I believe he also stated that a wealth management company approached him offering asset protection services. Unless I'm mistaken, these companies usually approach folks with net worth in excess of 1M. If 1M net worth is not considered wealthy, especially for someone in his late 20s/early 30s, then idk what is.

 

[Big Time Hoosier]

I have to hand it to @TanMan. He's being questioned for his posts and his responses are eloquent and non-personal. Well done.

And he supports the 2nd Amendment! Because, without the 2nd you couldn’t have the 1st or any others for that matter.



@TanMan, any chance I could convince you to buy this so I can live vicariously through you? Or, feel free to gift me the money to buy it for myself. Thanks, that’d be great.

Gunwerks Collective | The CoPilot - Ultimate Truck Gun - Gunwerks

Big Hoss

 

[ysrebob]

lol agreed;it's like watching a deposition. I also find it amusing that it's all fellow GPs that are questioning him (especially for endo work), not specialists.

If I recall correctly, TanMan posted that his office produced 2.5M+ in a year as a single doc office in less than five years out of dental school. Pretty impressive, particularly for a GP without a formal post-grad training like GPR/AEGD.

Regarding "truly wealthy don't show off" philosophy, I believe he also stated that a wealth management company approached him offering asset protection services. Unless I'm mistaken, these companies usually approach folks with net worth in excess of 1M. If 1M net worth is not considered wealthy, especially for someone in his late 20s/early 30s, then idk what is.

The issue isn't the quality of TanMan's work nor the veracity of what he's saying, which I for one do not question. On an anonymous forum we should try to assume the best of each other, and in any case TanMan's posts strongly suggest that he does care about maintaining a standard of care while achieving extreme efficiency. Just above I compared him to Tiger Woods in his prime, which ought to be a pretty good compliment.

The issue is that his results IMO could be replicated by very, very few people, and thus that he's wildly unrealistic example for student dentists to base major decisions about their own futures on. SDN is a forum for students and a this is a thread about how much school debt you can safely take on. TanMan's ability to single-handly produce $2.5M of general dentistry a year is NOT EVEN REMOTELY TYPICAL and any dental student who makes tuition/borrowing decisions based on the impression that they will be able to do something similar is going to be in for a rude awakening. I am not Tiger Woods and I do not have any unrealistic hopes of leaving dentistry to try to make a living as a pro golfer, no matter how much I might want to. Most dental students are not TanMan and should not plan on producing $2.5M/yr after they graduate to make that $500k student loan evaporate, no matter how much they might want to.

 

[TanMan]

And he supports the 2nd Amendment! Because, without the 2nd you couldn’t have the 1st or any others for that matter.



@TanMan, any chance I could convince you to buy this so I can live vicariously through you? Or, feel free to gift me the money to buy it for myself. Thanks, that’d be great.

Gunwerks Collective | The CoPilot - Ultimate Truck Gun - Gunwerks

Big Hoss

Man, I'm glad to see a fellow dentist and patriot support the 2nd Amendment. That's definitely a nice rifle and it'll be on my to-buy list if they don't run out. I got a suppressed Anzio 20mm and Fostech Origin 12 w/ 30rd drum on the way... trying to budget and not blow too much money on guns, haha.

It's sad how our 2nd Amendment rights are under attack, but seeing and hearing the atrocities against the people in Mexico and the idea of a disarmed populace just make me realize how sacred our 2A rights are. You're definitely right, without the 2nd, you don't have your other rights. Before anyone spouts about how I don't know anything about Mexico, I have many clients and friends who are from the other side and it's really sad that only the criminals and law enforcement have firearms... both are in cahoots with each other. You essentially have a defenseless population who cannot defend themselves or will be prosecuted if they try to defend themselves. Thankfully, we live in the good old USA, and I trust our law enforcement/border patrol/military to keep us safe. However, the old proverb goes, trust but verify. Our firearms are necessary to prevent oppression of the population. Another example that we hear on the news (but no personal experiences) are the people of Venezuela. Once you disarm the population, you can do whatever you want to them.

Anyway, there goes my 2A rant. I practice what I preach, and this is my EDC everywhere (including in the office):

The issue isn't the quality of TanMan's work nor the veracity of what he's saying, which I for one do not question. On an anonymous forum we should try to assume the best of each other, and in any case TanMan's posts strongly suggest that he does care about maintaining a standard of care while achieving extreme efficiency. Just above I compared him to Tiger Woods in his prime, which ought to be a pretty good compliment.

The issue is that his results IMO could be replicated by very, very few people, and thus that he's wildly unrealistic example for student dentists to base major decisions about their own futures on. SDN is a forum for students and a this is a thread about how much school debt you can safely take on. TanMan's ability to single-handly produce $2.5M of general dentistry a year is NOT EVEN REMOTELY TYPICAL and any dental student who makes tuition/borrowing decisions based on the impression that they will be able to do something similar is going to be in for a rude awakening. I am not Tiger Woods and I do not have any unrealistic hopes of leaving dentistry to try to make a living as a pro golfer, no matter how much I might want to. Most dental students are not TanMan and should not plan on producing $2.5M/yr after they graduate to make that $500k student loan evaporate, no matter how much they might want to.

There are always success stories and failures on both sides of the aisle. Whether a start-up or a practice acquisition. How much you can produce depends on your limits and your supply of patients. I encourage every potential practice owner to look deep in themselves to see if they have the drive to succeed. If you do, I think there's a very low chance you'll fail, regardless of the path that you choose. If you are very passive, just want to go through the motions, then you need a more structured path such as long term associateship, partnership buy-in(which I've heard many horror stories from friends), or practice acquisition.

Since I've been candid and open about my production, my question to current practice owner(s)... what would you say the production levels of an "average" dentist would be or your production if you would care to share?

When you can't work as fast or see as many patients as other dentists, you can't just assume that those dentists do worse dentistry than yours. If their work were bad and there were lots of redos, no patient would come and they wouldn't have a busy successful office. Some dentists have better clinical and chairtime management skills than others. I think what Taman described was the "doctor's time" spent on each patient....and not the overall procedural time. It's not unreasonable to prep a tooth in 10 minutes. Spending more time may make things worse....ie overtappering or over reduction of tooth structure. There are assistants with extended function (RDAEF) who can pack cords, take impression, make and deliver temp crowns for the dentist.

Having a lot of chairs is key. When I set up my office, I told the contractor to give me as many chairs as possible. I don't need a doctor's private office nor a staff lounge. I come to work hard and not to sit around waiting for patients to come. It's actually stressful not to have a busy schedule. That's why I book as many patients in 1 day as possible and use the free days in a month to work for corp office.

Man, I wish I had RDAEF's. I have to do most of the work in Texas. I can't even delegate anesthetic to the hygienists! I could probably be more productive and efficient if I had them. That's why I study the procedures to figure out how to go faster while maintaining quality. I don't pack cord, I trough with a laser. I'll definitely agree, juggling patients is a lot easier when you have a lot of overflow chairs. Chairs are typically the bottleneck, sans the dentist's speed.

Doctor time = procedural time, which does not equal time the patient is in the chair. Time that the patient is in the chair > actual doctor/procedural time.

 

[TanMan]

I don't like the idea of discouraging future dentists/colleagues, but I can see where my forum colleagues are coming from when they say it is atypical. The reality is that until you are working, you don't really know your full capabilities. You are definitely taking a gamble since YMMV when it comes to how fast/proficient you become as a dentist. Not everyone is equal, and for there to be an above average dentist, there has to be the below average dentist. Just like how you really don't know how it is to be dentist until you're actually a practicing dentist, you won't know your real world speed until you are knee deep in the profession. Unfortunately, you've already made your investment/dues to the profession at that time.

I think there are some characteristics that would give you a better prediction of whether you have the personality to handle volume...

- Concise and charismatic patient/personal communication skills. Can you develop a bond/relatable persona as time efficient as possible (without having to talk to them for 30+ mins to know their whole life story)
- "Just do it and gooooo" personality
- Able to stay composed in the most stressful of work quotas and difficult procedures/patients
- Able to think on your feet and strategically plan your next moves on the patient you're working on AND the next patients too (for example: while you're doing an rct and remembering the next patients are fills fills, another rct, hygiene cycle, etc... and knowing what to do, any strategy needed for when you get in there or is it just a straight forward procedure)
- Able to think outside of the box and looking to improve continuously instead of stagnating or getting comfortable.
- Able to get past a problem quickly or not getting hung up/stuck on a problem

I found an old photo of my schedule on the last week of 2016... blurred for patient privacy/HIPAA. Note those really long appointments! Those are the "my insurance is going to expire this week, can you do EVERYTHING?" This is a hygiene heavy schedule, I don't recall why ops fell apart here. Anyway, this is to let our future colleagues that anything is possible. I wouldn't have thought that I'd be able to juggle this patient volume until I was actually there. It's not always 13 chairs cycling through all the time per hour, but having those extra chairs ensures that the next hour doesn't wait to get a chair.

.

 

[2TH MVR]

Generally speaking ... I would believe that if the supply of new patients was endless ... then a competent dentist will find a way to be a @TanMan. I know in my hay day .... when patients were plentiful and there was less competition .... EVERY year was a new revenue record. You didn't even have to be a @TanMan and you would be successful. I just assumed that this upward trend would continue forever kind of like the housing bubble. Well ...of course it didn't.
My point is that from over 26 years of private practice ... the issue is NEW PATIENTS. Everyone is competing for them. GPs and Specialists. Privates and Corps. Even the Corp I'm working PT for now is competing with at least a dozen other Corps and Privates within a 2-3 mile radius. Corp meetings are all about getting more new patients in the door.
Without new patients .... the dentist business model fails.
Is there a magic advertisement that @TanMan uses? I used to think it was word-of-mouth and reputation. But that only gets you so far.
Again ... it's going to come down to LOCATION. RURAL vs. URBAN. Practice where no one else wants to practice.

In the right place with the right supply of new patients. And of course ... you need to work hard and fast.

 

[deleted659902]

Generally speaking ... I would believe that if the supply of new patients was endless ... then a competent dentist will find a way to be a @TanMan. I know in my hay day .... when patients were plentiful and there was less competition .... EVERY year was a new revenue record. You didn't even have to be a @TanMan and you would be successful. I just assumed that this upward trend would continue forever kind of like the housing bubble. Well ...of course it didn't.
My point is that from over 26 years of private practice ... the issue is NEW PATIENTS. Everyone is competing for them. GPs and Specialists. Privates and Corps. Even the Corp I'm working PT for now is competing with at least a dozen other Corps and Privates within a 2-3 mile radius. Corp meetings are all about getting more new patients in the door.
Without new patients .... the dentist business model fails.
Is there a magic advertisement that @TanMan uses? I used to think it was word-of-mouth and reputation. But that only gets you so far.
Again ... it's going to come down to LOCATION. RURAL vs. URBAN. Practice where no one else wants to practice.

In the right place with the right supply of new patients. And of course ... you need to work hard and fast.

Astute observations regarding high patient number (a corollary to a constant flow of new patients) being the key to TanMan's high production numbers...I believe he posted once that his active patient number was around 7k. With respect to his marketing strategy, he seems to be an advocate of search engine ads customized to PPO patient population (with even more customization that he considers "controversial")

low cost startup through boot-strapping (from the corporate stint and their bonuses) with used equipment and efficient office design (wall plumbing and mobile NO2 tanks rather than built-in) + business model based on convenient hours (and above average pricing) + profit sharing incentives for employees + favorable location with low competition (suburban TX?) + business background (parents owned a small business) + aggressive marketing plan using all channels that yield high active patient # = TanMan's blueprint to 2M+/yr GP practice

The only downside is that this does not seem like a sustainable business model especially as a single doc office. I believe he works five days/wk and had to see a physical therapist for doing too many extractions once...On a related note and more interestingly, TanMan appears to regard dentistry as a small company from which to generate income that can support outside, risky investment opportunities for early retirement and seems to be waiting for the right "exit opportunity" so to speak. This is a stark contrast to many of pre-dental and dental students' view of dentistry as a life-long career that can support them financially well into their 50s and 60s with their future investments mostly in traditional vehicles including stocks/bonds and real estate.

 

[TanMan]

I consider myself pretty fast and efficient and good at running multiple chairs. But there is absolutely no way in hell i can run 4 dentist chairs plus 4 hygiene recall chairs. I honestly think there is no way either given that even for hygiene recall you’d want to greet the patient, take a good hard and soft tissue look, and examine the radiographs and go over any questions the hygienist/patient may have. That alone for each patient should take about 10 minutes of dentist chair time for a quality exam.

As for a 45 min molar rct/bu/crown, that’s also extremely suspect. Any competent dentist should know that the key to a good molar (or any) Endo is to find all canals, do thorough debridement, rinse repeatedly and thoroughly, and get a good fill. The buildup also has to be done incrementally to minimized the c factor and also ensure a good seal. The crown might be the easiest part but in certain mouths where opening is limited and tongue is in the way it can also be hard. The disinfection process alone should take at least15 minutes for the hypochlorite to soak and disinfect. An Endo activator can assist but time duration is still a critical factor.

This guy Tanman if I recall has actually shown photos of his putative cars. I am firmly in the camp of the Millionaire Next Door philosophy. The truly wealthy don’t flaunt their wealth and it’s the stealth wealth guys that have the real money. JMHO.

I thought of the other way I do RCT/bu/crown but forgot to post it in the other post... If you have no interproximal decay, you have good keratinized attached tissue, and the height of contour of the tooth is not too gingival, you can prep the crown first, scan for CEREC, while the crown is being made, do your RCT, finish before the crown is made, and finish the buildup and cementation in less than an hour (chairtime and doctortime). This requires good case selection, to make sure that you don't have recession that exposes your crown margins. If the patient has a thin gingival biotype, the rubber dam clamp will definitely cause a bit more recession, if the HOC is too low, more prone to recession due to needing a more aggressive clamp, and interproximal decay compromises the wall that's going to hold your naocl in there. In essence, the described technique is best for molars. If you try this on the anteriors/premolars, you risk having recession of the gingiva from your margins.

 

[TanMan]

Astute observations regarding high patient number (a corollary to a constant flow of new patients) being the key to TanMan's high production numbers...I believe he posted once that his active patient number was around 7k. With respect to his marketing strategy, he seems to be an advocate of search engine ads customized to PPO patient population (with even more customization that he considers "controversial")

low cost startup through boot-strapping (from the corporate stint and their bonuses) with used equipment and efficient office design (wall plumbing and mobile NO2 tanks rather than built-in) + business model based on convenient hours (and above average pricing) + profit sharing incentives for employees + favorable location with low competition (suburban TX?) + business background (parents owned a small business) + aggressive marketing plan using all channels that yield high active patient # = TanMan's blueprint to 2M+/yr GP practice

The only downside is that this does not seem like a sustainable business model especially as a single doc office. I believe he works five days/wk and had to see a physical therapist for doing too many extractions once...On a related note and more interestingly, TanMan appears to regard dentistry as a small company from which to generate income that can support outside, risky investment opportunities for early retirement and seems to be waiting for the right "exit opportunity" so to speak. This is a stark contrast to many of pre-dental and dental students' view of dentistry as a life-long career that can support them financially well into their 50s and 60s with their future investments mostly in traditional vehicles including stocks/bonds and real estate.

Someone's been taking notes
Pretty spot on though on the summary. Thank god I don't need to see a PT anymore. The aches go away after sleeping. The model is not sustainable for a long time (decades), but if you can produce 2M+ per year, you shouldn't have to do this for a long time.

If you make it big from my advice, remember poor old TanMan and hook me up with some of that dental monies.

 

[DocJL]

lol agreed;it's like watching a deposition. I also find it amusing that it's all fellow GPs that are questioning him (especially for endo work), not specialists.

If I recall correctly, TanMan posted that his office produced 2.5M+ in a year as a single doc office in less than five years out of dental school. Pretty impressive, particularly for a GP without a formal post-grad training like GPR/AEGD.

Regarding "truly wealthy don't show off" philosophy, I believe he also stated that a wealth management company approached him offering asset protection services. Unless I'm mistaken, these companies usually approach folks with net worth in excess of 1M. If 1M net worth is not considered wealthy, especially for someone in his late 20s/early 30s, then idk what is.

Not sure why you find it amusing? You are being very dismissive of the very people who ARE experts in this arena.

It's logical, really. Realities are being pointed out by the people who are in the trenches of a general practice day to day. Once you have gotten into practice, particularly if you are right out of school, you will find out how much work it is to do $4k worth of dentistry a day (NOT easy as a new dentist, particularly if you value quality - no matter HOW GOOD any given practicioner is, SPEED and QUALITY will ALWAYS have an inverse relationship, ie, even a great clinician will do their best work if they are not in a hurry. After several years, $4k is easy, and $8-$10k is the point where I have to work quickly and efficiently on any given day where that much production is scheduled.

Keep in mind that most dentists are highly dependent on insurance fee schedules in order to keep a flow of new patients, so expect about $100 for a composite, and $600-700 for a BU and crown. Anybody who thinks as a young fresh faced no experienced dental school grad that they can open a fee for service practice and expect people to pay them $1100 for a crown are in for a rude awakening. The people who are willing and able to pay those fees DO expect to be seeing an experienced doctor with an established reputation.


The specialists (ortho in this case), particularly if they did not practice for several years as a general dentist before going into residency, do not have the same experiences as an experienced private practice dentist-OWNER. One can look at it this way: A general dentist spends their day doing procedures from $100 to $1000. A specialist spends their day doing procedures form $1000 to $10,000. Obviously not the same number of patients. And also a quite different type of practice completely, in terms of day to day operations.

As far as wealth management companies? Meh. They approach anyone with an MD or DDS behind their name. I was getting mail from them when I was a military dentist.

 

[TanMan]

Not sure why you find it amusing? You are being very dismissive of the very people who ARE experts in this arena.

It's logical, really. Realities are being pointed out by the people who are in the trenches of a general practice day to day. Once you have gotten into practice, particularly if you are right out of school, you will find out how much work it is to do $4k worth of dentistry a day (NOT easy as a new dentist, particularly if you value quality - no matter HOW GOOD any given practicioner is, SPEED and QUALITY will ALWAYS have an inverse relationship, ie, even a great clinician will do their best work if they are not in a hurry. After several years, $4k is easy, and $8-$10k is the point where I have to work quickly and efficiently on any given day where that much production is scheduled.

Keep in mind that most dentists are highly dependent on insurance fee schedules in order to keep a flow of new patients, so expect about $100 for a composite, and $600-700 for a BU and crown. Anybody who thinks as a young fresh faced no experienced dental school grad that they can open a fee for service practice and expect people to pay them $1100 for a crown are in for a rude awakening. The people who are willing and able to pay those fees DO expect to be seeing an experienced doctor with an established reputation.


The specialists (ortho in this case), particularly if they did not practice for several years as a general dentist before going into residency, do not have the same experiences as an experienced private practice dentist-OWNER. One can look at it this way: A general dentist spends their day doing procedures from $100 to $1000. A specialist spends their day doing procedures form $1000 to $10,000. Obviously not the same number of patients. And also a quite different type of practice completely, in terms of day to day operations.

As far as wealth management companies? Meh. They approach anyone with an MD or DDS behind their name. I was getting mail from them when I was a military dentist.

You have a very good point. PPO fees are quite a bit lower, so you better be fast on your feet to make money. Making a target of 1500-2000USD per hour of production can be difficult unless you are able to juggle multiple procedures at the same time. You cannot get stuck troubleshooting a procedure for a very long time. That's why I like single tooth procedures a LOT. I don't have much unpaid, unbillable hours (such as comprehensive tx planning/FMR's). On the idea that FFS patients won't go to a newgrad is not necessarily true. All that goes out the door when the patient just wants to get out of pain, they'll go to anyone that'll see them immediately. Now, you can't expect this to be the case with every patient, but if you setup your practice to be that emergency FFS/PPO practice to go to, then objections typically go out the door.

I don't think that speed and quality always have an inverse relationship. An example that happens to me frequently is when I obsess over a class IV restoration and I'm trying to shape and develop the line angles... BAM, messed with it too much and overreduced. Gotta do it all over again. Same with excessive instrumentation, overtapering, etc... Taking longer opens more variables to screwing up something during that time. Look at it from the patient's perspective. Do you really want someone in your mouth for hours at a time, or would you prefer that the dentist is in and out quickly as long as it didn't hurt, doesn't hurt afterwards, looks good, and doesn't fall apart?

 

[321931]

I like how the baseline of dentistry has become these major outliers like Tanman's experience. He earned what he got. Great. But to extrapolate that if you follow his recipe, if you work hard, you will achieve what he gets....is nonsensical. There's no use explaining this to non-dentists/non-owners. The people posting that already own practices know this, and keep fighting this ridiculous fight to curve expectations of pre-dents/dental students see the realities. But na, it won't work, don't waste your time. The ADA posts averages for a reason. Go look at the averages and make up your own mind. Most of you and the dental class will be average or even below average. Striving to be the top 1% is admirable but takes a whole variety of factors...one of which is luck which you can't control. Good luck! No pun intended lol.

Broskis get back to reality. Pass them boards, get your license, and I will be waiting to hear about your success and non success in a few years.

 

[endoaccess]

Rainee is right.

I really like reading Tanman's posts for the entertainment value though. Kind of like watching pro sports. It's fun to imagine we could do what he's doing. But there is a reason 99% of dentists are not.

There was somewhere on SDN he posted a blurry picture of his daily clinic schedule. It was so absurd I couldn't believe it. I've never seen anything like it. To be able to manage that schedule and the staff to support it day-in and day-out is an incredible feat. Very, very, VERY few dentists would be able to manage that. He is earning his money. Guys like that do not even really need dentistry, he would probably be very successful in anything.

Tanman: How many patient encounters do you have on a typical day?

 

[charlestweed]

Like Tanman, I also book as many patients in one day as my staff and I can handle so I only need to work a few days in a month. And for the other free days in the month, instead of sitting around doing nothing, I work for Corp offices to earn extra income. Like Tanman, I also get criticized by some of my colleagues at the orthotown forum when I posted my work schedule, which looks very similar to Taman's one (actually, it's almost 2x busier than his....that's because orthodontists can see a lot more patients).

The reason Tanman and I have positive posts about our jobs is we are ok with working on weekends, working non-stop, jumping from chair to chair etc. We are actually happy when our appt books are full. The ones, who view these as a downside of dentistry, will say it's not worth pursuing.

 

[endoaccess]

Like Tanman, I also book as many patients in one day as my staff and I can handle so I only need to work a few days in a month. And for the other free days in the month, instead of sitting around doing nothing, I work for Corp offices to earn extra income. Like Tanman, I also get criticized by some of my colleagues at the orthotown forum when I posted my work schedule, which looks very similar to Taman's one (actually, it's almost 2x busier than his....that's because orthodontists can see a lot more patients).

The reason Tanman and I have positive posts about our jobs is we are ok with working on weekends, working non-stop, jumping from chair to chair etc. We are actually happy when our appt books are full. The ones, who view these as a downside of dentistry, will say it's not worth pursuing.

I'm not sure anyone is criticizing Tanman, we're just trying inject some perspective so dental students don't have such unrealistic expectations. I have a friend with a solo $2mil practice so I'm familiar with this type of dentist. 99% of dentists do not have the traits my friend has, and could never keep it going. It is a combination of extreme charisma, boundless energy, CEO leadership skills, top notch dental skills, perfect location and a bit of luck. Many dentists have 2 or 3 of these, very few have all. My friend would be successful in any business endeavor. Honestly I think he would make even more money in another field. He makes a lot of money because of who he is, not because he has a DDS. A DDS gets someone a $130k job.

Anyways, you're an Ortho. Totally different ball game seeing such a volume of patients. You don't have to give blocks, you do the same thing day in day out, you delegate most things to assistants. You don't deal with all the curveballs a GP has on a daily basis. It's really not the same kind of thing. It's why ortho is great.

 

[charlestweed]

I'm not sure anyone is criticizing Tanman, we're just trying inject some perspective so dental students don't have such unrealistic expectations. I have a friend with a solo $2mil practice so I'm familiar with this type of dentist. 99% of dentists do not have the traits my friend has, and could never keep it going. It is a combination of extreme charisma, boundless energy, CEO leadership skills, top notch dental skills, perfect location and a bit of luck. Many dentists have 2 or 3 of these, very few have all. My friend would be successful in any business endeavor. Honestly I think he would make even more money in another field. He makes a lot of money because of who he is, not because he has a DDS. A DDS gets someone a $130k job.

Anyways, you're an Ortho. Totally different ball game seeing such a volume of patients. You don't have to give blocks, you do the same thing day in day out, you delegate most things to assistants. You don't deal with all the curveballs a GP has on a daily basis. It's really not the same kind of thing. It's why ortho is great.

What you said about ortho is very true and yet, many of my ortho colleagues still think what I do can't be possible. Some think their job is hard.

 

[Shunwei]

Rainee is right.

I really like reading Tanman's posts for the entertainment value though. Kind of like watching pro sports. It's fun to imagine we could do what he's doing. But there is a reason 99% of dentists are not.

There was somewhere on SDN he posted a blurry picture of his daily clinic schedule. It was so absurd I couldn't believe it. I've never seen anything like it. To be able to manage that schedule and the staff to support it day-in and day-out is an incredible feat. Very, very, VERY few dentists would be able to manage that. He is earning his money. Guys like that do not even really need dentistry, he would probably be very successful in anything.

Tanman: How many patient encounters do you have on a typical day?

I don’t think there is any real sense in talking or advising about this to predents. Frankly I have never really read Tanman’s posts other than the few shorter initial ones in the beginning; the later ones feel like novels and my attention span nowadays simply doesn’t allow me to finish the verbose text and the repetitious material, and for someone who proclaims to be so busy he certainly has a lot of time to post those novels. Honestly I have a lot of doubt about what he does but it doesn’t really matter . . . . I have never met anyone that can handle what he claims to handle and the few that I know have tried provide crap quality care. Not saying he is but usually there is an inverse relationship there, and I am a pragmatist. But whatever.

Personally, I consider myself fairly successful in taking a failing practice from an old idiot dentist and turned it around in a few years. I am currently due to be completely debt free in 6 months and will have paid off 720k in 31 months. But I am not going to be a cheerleader like Tweedy here and say that “If I can do it, you can do it.” Nah. I am pretty good with business and dentistry and got it done, but would not recommend the field or the experience to anyone I care about. To spend 500k for a basic dental license nowadays and possibly 2x or 3x more to get your foot into the business is just crazy. No way. But I am not here to advise.

I used to spend quite a bit of time on here when I was a predent and a dental student but found out over time that as with any Internet forum there is bound to be a lot of junk, drama, and fictitious stuff. It is up to the individual to apply the sniff test to filter out what is good content and what’s not. It’s common sense, really.

 

[TanMan]

Rainee is right.

I really like reading Tanman's posts for the entertainment value though. Kind of like watching pro sports. It's fun to imagine we could do what he's doing. But there is a reason 99% of dentists are not.

There was somewhere on SDN he posted a blurry picture of his daily clinic schedule. It was so absurd I couldn't believe it. I've never seen anything like it. To be able to manage that schedule and the staff to support it day-in and day-out is an incredible feat. Very, very, VERY few dentists would be able to manage that. He is earning his money. Guys like that do not even really need dentistry, he would probably be very successful in anything.

Tanman: How many patient encounters do you have on a typical day?

40-65+ patients a day (estimate), sometimes more, rarely less.

Like Tanman, I also book as many patients in one day as my staff and I can handle so I only need to work a few days in a month. And for the other free days in the month, instead of sitting around doing nothing, I work for Corp offices to earn extra income. Like Tanman, I also get criticized by some of my colleagues at the orthotown forum when I posted my work schedule, which looks very similar to Taman's one (actually, it's almost 2x busier than his....that's because orthodontists can see a lot more patients).

The reason Tanman and I have positive posts about our jobs is we are ok with working on weekends, working non-stop, jumping from chair to chair etc. We are actually happy when our appt books are full. The ones, who view these as a downside of dentistry, will say it's not worth pursuing.

Charlestweed's work philosophy is definitely respectable and becoming a more rare sight these days. Seeing a full schedule can sometimes spook me, but the overwhelming desire to get through the day takes all the anxiety out of seeing all the patients. Having a full schedule is definitely better than having an empty schedule.

I don’t think there is any real sense in talking or advising about this to predents. Frankly I have never really read Tanman’s posts other than the few shorter initial ones in the beginning; the later ones feel like novels and my attention span nowadays simply doesn’t allow me to finish the verbose text and the repetitious material, and for someone who proclaims to be so busy he certainly has a lot of time to post those novels. Honestly I have a lot of doubt about what he does but it doesn’t really matter . . . . I have never met anyone that can handle what he claims to handle and the few that I know have tried provide crap quality care. Not saying he is but usually there is an inverse relationship there, and I am a pragmatist. But whatever.

Personally, I consider myself fairly successful in taking a failing practice from an old idiot dentist and turned it around in a few years. I am currently due to be completely debt free in 6 months and will have paid off 720k in 31 months. But I am not going to be a cheerleader like Tweedy here and say that “If I can do it, you can do it.” Nah. I am pretty good with business and dentistry and got it done, but would not recommend the field or the experience to anyone I care about. To spend 500k for a basic dental license nowadays and possibly 2x or 3x more to get your foot into the business is just crazy. No way. But I am not here to advise.

I used to spend quite a bit of time on here when I was a predent and a dental student but found out over time that as with any Internet forum there is bound to be a lot of junk, drama, and fictitious stuff. It is up to the individual to apply the sniff test to filter out what is good content and what’s not. It’s common sense, really.

I am pretty verbose about what I write when it comes to relevant on-topic material. Those long "novels" that I write are essentially the thought processes that go through my head in writing form. Although I'm busy, I only work 33 hours per week at the dental office. I have plenty of time to do other stuff like write "novels" to help people out. I've read some of your posts, and they seem to be mostly about your loans, how great you are, dentistry is bad, and predents are ignorant. I don't really have to go into detail for people to come to their own conclusions about you and your message of doom. That last paragraph, sounds like you're ragequitting .

On a lighter note, I got half of my 20mm rifle in (barrel, muzzlebrake, 3 round mag)... lower receiver still needs atf approval:

 

[kingme23]

I don’t think there is any real sense in talking or advising about this to predents. Frankly I have never really read Tanman’s posts other than the few shorter initial ones in the beginning; the later ones feel like novels and my attention span nowadays simply doesn’t allow me to finish the verbose text and the repetitious material, and for someone who proclaims to be so busy he certainly has a lot of time to post those novels. Honestly I have a lot of doubt about what he does but it doesn’t really matter . . . . I have never met anyone that can handle what he claims to handle and the few that I know have tried provide crap quality care. Not saying he is but usually there is an inverse relationship there, and I am a pragmatist. But whatever.

Personally, I consider myself fairly successful in taking a failing practice from an old idiot dentist and turned it around in a few years. I am currently due to be completely debt free in 6 months and will have paid off 720k in 31 months. But I am not going to be a cheerleader like Tweedy here and say that “If I can do it, you can do it.” Nah. I am pretty good with business and dentistry and got it done, but would not recommend the field or the experience to anyone I care about. To spend 500k for a basic dental license nowadays and possibly 2x or 3x more to get your foot into the business is just crazy. No way. But I am not here to advise.

I used to spend quite a bit of time on here when I was a predent and a dental student but found out over time that as with any Internet forum there is bound to be a lot of junk, drama, and fictitious stuff. It is up to the individual to apply the sniff test to filter out what is good content and what’s not. It’s common sense, really.

Would you care to speak up then about your financials? It seems like a lot of people have a problem w/ Tanmans message, but I don’t hear many of them opening up about their practices like he is willing to (not pointing to you specifically). If you guys don’t like what he is offering up, then let us hear more about your collections/OH/costs/location etc so we can get a more realistic idea. The ADA averages are dependent on so many factors that they have no meaning at all to anyone reading.

Btw knocking out 720K in 2 and a half years? I’m failing to see the problem with dentistry.

 

[schmoob]

40-65+ patients a day (estimate), sometimes more, rarely less.



Charlestweed's work philosophy is definitely respectable and becoming a more rare sight these days. Seeing a full schedule can sometimes spook me, but the overwhelming desire to get through the day takes all the anxiety out of seeing all the patients. Having a full schedule is definitely better than having an empty schedule.



I am pretty verbose about what I write when it comes to relevant on-topic material. Those long "novels" that I write are essentially the thought processes that go through my head in writing form. Although I'm busy, I only work 33 hours per week at the dental office. I have plenty of time to do other stuff like write "novels" to help people out. I've read some of your posts, and they seem to be mostly about your loans, how great you are, dentistry is bad, and predents are ignorant. I don't really have to go into detail for people to come to their own conclusions about you and your message of doom. That last paragraph, sounds like you're ragequitting .

On a lighter note, I got half of my 20mm rifle in (barrel, muzzlebrake, 3 round mag)... lower receiver still needs atf approval:

View attachment 238418

20MM?!?! Do you have a Phalanx in the backyard?!?!?

 

[2TH MVR]

Look. You do what you do. If you like to see a ton of patients due to economics or the need to be a baller ... then fine. It's your practice to do as you want. I've been there. Done that. Enjoyed the economic rewards. During my early years I had a staff of 8-9 and we were seeing 100 plus patients a day. Very productive, but with that volume ..... the day can be stressful, but productive and very financially rewarding.

As you get older ..... I prefer a slower pace with fewer patients. I see 40-60 patients a day at Corp. Busy, but very manageable. I actually enjoy spending more time with the patients doing more exacting treatment. Do I get validation at a Corp office for the extra effort I put in? Absolutely not. My validation comes from within.

As for @TanMan. Yes .... he is an outlier, but it can be done and it is being done. I was doing the same thing 20 years ago as an Ortho.

But the take home message for new dents is ..... and I've said this before .... is NEW PATIENTS. You can't be a @TanMan if you do not have a system of attracting NEW PATIENTS consistently. That's the key. The problem with most predents and new dentists is that they think the patients will simply walk through their doors in droves. Not true. Especially in saturated, urban, popular cities.

Predents/new dentists shouldn't be enamored with how @TanMan sees and treats so many patients in a day. They should be asking how he keeps his supply of new patients coming in. That's the key.

 

[charlestweed]

They should be asking how he keeps his supply of new patients coming in. That's the key.

Weekend office hours, reasonable fees, being honest, no BS tx plans, quality work, few redos, efficient doctor who gets things done fast, less wait time for patients etc. Nobody wants to wait forever just to get 1 filling done.

 

[beannaithe]

It seems like a lot of people have a problem w/ Tanmans message, but I don’t hear many of them opening up about their practices like he is willing to (not pointing to you specifically). If you guys don’t like what he is offering up, then let us hear more about your collections/OH/costs/location etc so we can get a more realistic idea.

I don't think it's that a lot of people have a problem with TanMan's message. I think it's that he tells you how easy it is, when really it's not. Well, it probably is easy to TanMan, but I have met few dentists that can do it. I associate at an office that runs a similar schedule to his, but it has 3 (2 working any given day) dentists to see all the patients and check hygiene. I've covered the office many times alone and let me tell you, it's extremely difficult to focus your attention on the procedure at hand while there's 3-4 hygienists breathing down your neck and wondering whether or not the side book is here yet. Like really, really hard. I couldn't do it every single day, day in and day out. I give TanMan props about being able to do it, but I truly think a rare few can keep up. After I had my first kid, I cut my hours because I got so burnt out from dentistry and new motherhood.

Keep in mind that collections aren't going up like they used to. Insurance companies are slashing reimbursements at every turn. We had our rates cut 10-20% over 3 years. When I started at this practice, we got an average of $750/crown and now we're getting around $625. Some are in the $550 range. Staff salaries have risen, lab costs have risen, material costs have risen. Companies just started raising fees again this year, but it's $0.10 - $1 a procedure. To keep collections stable, you need to do more procedures and quicker. To do that, you need to add staff which increases overhead. Where I work collections are through the roof, but so is overhead. Quality staff costs money as do the benefits to keep them happy. If you want people you can trust to do things right and be able to delegate, you are going to need to pay for them. If you have a crap assistant/front desk, it will just increase the work for you.

As charlestweed said, keeping NPs flowing in the door is key. My boss has been very lucky. Very, very lucky. He bought a long-standing practice in a small city neighborhood with a great word of mouth reputation. Even though the area is saturated, he found the right practice in the right location at the right time. He is in network with tons of insurance companies. The office has 2 late nights as well as early morning hours. The doors are open about 45 hours a week. We also use expanded assistants to place restorations if we get caught up in hygiene so patients almost never wait. Patients absolutely love it because they are in and out. He does minimal advertising as word of mouth and existing patients keep us busy. As soon as there's a dip, he can throw some ads out and fill the schedule.

And charlestweed does give a lot of realistic advice. As far as kids, they are wonderful and expensive. I'm due with #2 in the winter and daycare for both will cost more than my student loan payments. And that's not even getting into food and activities and diapers. Hiring a nanny to keep busting at work might work great for some people, but it's a lot harder in practice. Personally, I couldn't do it. For me, I took the flexible career to be there my kids while grow up.

Full disclosure, I am the typical mommy doctor. I work 3 days a week, 20 hours, banker's hours except for 1 night. I make around $130k/year. Most of my paycheck goes to taxes, paying off student loans early and daycare. I could work more and make more, but my priorities changed when I started my family.

 

[2TH MVR]

One of the cool things about dentistry is that you can practice how you want to practice. I know one dentist (let's call him Tanman wanabe) who bought his dad's practice. Expanded the building. Doubled the staff. Hired 1-2 associates. Hired a practice consultant. Lectured. Rarely referred out any procedures. 7-10 chairs all going at the same time. High production. High collections. High overhead. High stress. My other dentist friend (Average Dentist) was happy in his 1000 sq ft office and 3 staff members. He saw one patient at a time and rarely pushed himself. Stress free. Stayed away from HMO/PPOs. Essentially all FFS. Low overhead .... good collections. Both of these dentists had 2nd homes, nice cars, families, funded retirement, etc. etc.

There's no set formula on how you should practice. Dentistry offers independence. Not necessarily high,high income. Many, many different ways to practice.

 

[TanMan]

20MM?!?! Do you have a Phalanx in the backyard?!?!?

I wish. I wanted to mount it onto a jeep or humvee, but I think a full auto belt fed 50 cal might be more practical as a vehicle mount

Look. You do what you do. If you like to see a ton of patients due to economics or the need to be a baller ... then fine. It's your practice to do as you want. I've been there. Done that. Enjoyed the economic rewards. During my early years I had a staff of 8-9 and we were seeing 100 plus patients a day. Very productive, but with that volume ..... the day can be stressful, but productive and very financially rewarding.

As you get older ..... I prefer a slower pace with fewer patients. I see 40-60 patients a day at Corp. Busy, but very manageable. I actually enjoy spending more time with the patients doing more exacting treatment. Do I get validation at a Corp office for the extra effort I put in? Absolutely not. My validation comes from within.

As for @TanMan. Yes .... he is an outlier, but it can be done and it is being done. I was doing the same thing 20 years ago as an Ortho.

But the take home message for new dents is ..... and I've said this before .... is NEW PATIENTS. You can't be a @TanMan if you do not have a system of attracting NEW PATIENTS consistently. That's the key. The problem with most predents and new dentists is that they think the patients will simply walk through their doors in droves. Not true. Especially in saturated, urban, popular cities.

Predents/new dentists shouldn't be enamored with how @TanMan sees and treats so many patients in a day. They should be asking how he keeps his supply of new patients coming in. That's the key.

The key is advertising a LOT and have something to offer. The system definitely relies on new patients coming in. Eventually, the recall columns get saturated and production/patient decreases. I don't think this rate is sustainable for a long time and eventually, your body or mind will give out. If you can handle stress, it's a good system for maybe 10 years. If you tend to break down or shut down in the face of stress, the high volume system is not for you.

I don't think it's that a lot of people have a problem with TanMan's message. I think it's that he tells you how easy it is, when really it's not. Well, it probably is easy to TanMan, but I have met few dentists that can do it. I associate at an office that runs a similar schedule to his, but it has 3 (2 working any given day) dentists to see all the patients and check hygiene. I've covered the office many times alone and let me tell you, it's extremely difficult to focus your attention on the procedure at hand while there's 3-4 hygienists breathing down your neck and wondering whether or not the side book is here yet. Like really, really hard. I couldn't do it every single day, day in and day out. I give TanMan props about being able to do it, but I truly think a rare few can keep up. After I had my first kid, I cut my hours because I got so burnt out from dentistry and new motherhood.

Keep in mind that collections aren't going up like they used to. Insurance companies are slashing reimbursements at every turn. We had our rates cut 10-20% over 3 years. When I started at this practice, we got an average of $750/crown and now we're getting around $625. Some are in the $550 range. Staff salaries have risen, lab costs have risen, material costs have risen. Companies just started raising fees again this year, but it's $0.10 - $1 a procedure. To keep collections stable, you need to do more procedures and quicker. To do that, you need to add staff which increases overhead. Where I work collections are through the roof, but so is overhead. Quality staff costs money as do the benefits to keep them happy. If you want people you can trust to do things right and be able to delegate, you are going to need to pay for them. If you have a crap assistant/front desk, it will just increase the work for you.

As charlestweed said, keeping NPs flowing in the door is key. My boss has been very lucky. Very, very lucky. He bought a long-standing practice in a small city neighborhood with a great word of mouth reputation. Even though the area is saturated, he found the right practice in the right location at the right time. He is in network with tons of insurance companies. The office has 2 late nights as well as early morning hours. The doors are open about 45 hours a week. We also use expanded assistants to place restorations if we get caught up in hygiene so patients almost never wait. Patients absolutely love it because they are in and out. He does minimal advertising as word of mouth and existing patients keep us busy. As soon as there's a dip, he can throw some ads out and fill the schedule.

And charlestweed does give a lot of realistic advice. As far as kids, they are wonderful and expensive. I'm due with #2 in the winter and daycare for both will cost more than my student loan payments. And that's not even getting into food and activities and diapers. Hiring a nanny to keep busting at work might work great for some people, but it's a lot harder in practice. Personally, I couldn't do it. For me, I took the flexible career to be there my kids while grow up.

Full disclosure, I am the typical mommy doctor. I work 3 days a week, 20 hours, banker's hours except for 1 night. I make around $130k/year. Most of my paycheck goes to taxes, paying off student loans early and daycare. I could work more and make more, but my priorities changed when I started my family.

High volume is not easy, but it's not impossible like others make it out to be. My system comes out out to having up to 7 hyg/6 ops per hour. That's essentially the key... payments are not getting any higher, costs are going up. Either produce more, charge more, or reduce operating costs. If your practice is mostly PPO, you're bound by what you can charge unless you treatment plan non-covered services and your state allows you to charge whatever you want for non-covered services. However, treatment acceptance may be affected if out of pocket expenses increase, depending on the price sensitivity of your patient population. Your alternative is penny pinching on your supplies and material costs. I think that cost savings on supplies with possible compromise of quality is not worth it; for example, if supplies account for 5% of your gross revenue, and you save 20%, 1% is not much IF the quality is compromised. If there's no compromise in quality, then you should definitely go cheaper. Redos can be time consuming and costs you in productivity. The other option (which I think makes the most sense) is to increase your productivity. If your state allows EFDA's, you should definitely have an army of them if you have the volume. You have to figure out how to become more efficient at doing your procedures and minimizing failures at the same time. Doctor time (your time) is the most important time. Hygiene time is the second most expensive time. The lubricant that makes the system flow is your assistants. They are your key to having a smooth and efficient office. Anything that can be legally delegated should be delegated. Once you start to fill to beyond capacity (wait times increasing, 1-2 weeks booked solid), then you can start trimming the non-productive procedures. Calculate the time and overhead taken by each procedure, and see which ones you can start trimming. That gives you more time to do the procedures that you want to do (that may or may not be more profitable, depending if profit or enjoyment is your main objective).

One thing that I probably have not mentioned, although good staff is hard to find, they CANNOT be deemed irreplaceable in your practice. Everyone should be able to be replaced, if needed. Otherwise, the balance of power and bargaining power flips to their side. My best assistant left and I refuse to rehire because it sets a bad example to the rest of the staff. I keep them there with above market rates, but no benefits.

One of the cool things about dentistry is that you can practice how you want to practice. I know one dentist (let's call him Tanman wanabe) who bought his dad's practice. Expanded the building. Doubled the staff. Hired 1-2 associates. Hired a practice consultant. Lectured. Rarely referred out any procedures. 7-10 chairs all going at the same time. High production. High collections. High overhead. High stress. My other dentist friend (Average Dentist) was happy in his 1000 sq ft office and 3 staff members. He saw one patient at a time and rarely pushed himself. Stress free. Stayed away from HMO/PPOs. Essentially all FFS. Low overhead .... good collections. Both of these dentists had 2nd homes, nice cars, families, funded retirement, etc. etc.

There's no set formula on how you should practice. Dentistry offers independence. Not necessarily high,high income. Many, many different ways to practice.

That is true... there is no set way to practice, but if you have a lot of debt service payments to make, it's important to maximize your profitability as much as you can. You could have a small practice, but unless you're producing a lot per patient, you may not be able to make your debt payments. After becoming more financially stable, I think people can practice any way they want without the downwards financial pressure placed by taking on large debt. It's important that as production increases, overhead should not increase more than what the current proportions would be. Otherwise, you have diminishing returns for every x amount produced.

@2TH MVR has a good point. There's more than one way to practice in dentistry. However, if you're going to take 400k+ in debt, I would advocate a more aggressive strategy early on while you still have your youth and energy. Then you can choose to tone it down afterwards if you want. Abundance of money will not make you happy, but the lack thereof will definitely make you unhappy.

 

[kingme23]

It’d be great to hear from someone like @Cold Front who has also been extremely successful in practice, AFAIK without doing the mega “high volume” that TM does. At least up until his peds practice.

 

[Cold Front]

It’d be great to hear from someone like @Cold Front who has also been extremely successful in practice, AFAIK without doing the mega “high volume” that TM does. At least up until his peds practice.

I barely check these forums these days.

I would say with a good plan, Dentistry is still strong and the right profession to pursue. Ofcourse a lot depends on the dentist, ambitions, business knowledge and where he/she practices.

I have been fortunate to cut back on Dentistry a lot and put my hard earned money from 8 years in Dentistry into other businesses. During those 8 years, I opened multiple offices and bought commercial buildings, and now work 3 days a week and don’t plan to work as hard as those first 8 years in my career ever again. I went through a lot of stress, gained about 10 lbs, even triggered shingles from the stress. However, I’m happy now and have a lot of time to catch up with life and travel more. I’m turning 40 this year... and I think Dentistry has been good to me, but it came at a cost; hard work and patience.

Would I do it all over again? You bet! I believe in working towards a long term plan and gain for short term pain. I think any dentist can do what I did, but not every dentist wants to work really hard and have the patience to make it in the long.

So, yes, I still believe in Dentistry.

 

[2TH MVR]

The current economic position of dentistry seems to be dominated by growing Corporate Dentistry, saturation in the major cities, ridiculous student loan debt, insurance reimbursements not keeping up with inflation, technology such as aligners (hurting orthos), Boomer Gen reduction in numbers replaced by Millennials struggling to gain an economic foothold post Great Recession, etc. etc.

Is the current environment conducive to more, younger versions of extreme outliers like @Cold Front, @TanMan, etc. etc. Is it harder for a new dentist to be an outlier nowadays? Maybe. Maybe not. I guess there will always be a super talented bright dentist that finds a way to beat the system.

I guess my point is ..... in the old days ..... working really hard often led to success. Is that still the case now? Seems like you need hard work and luck sometimes to be an outlier.

 

[aggie-master]

Keep in mind that most dentists are highly dependent on insurance fee schedules in order to keep a flow of new patients, so expect about $100 for a composite, and $600-700 for a BU and crown. Anybody who thinks as a young fresh faced no experienced dental school grad that they can open a fee for service practice and expect people to pay them $1100 for a crown are in for a rude awakening. The people who are willing and able to pay those fees DO expect to be seeing an experienced doctor with an established reputation.

Try Unlock the PPO. The average fee collected for a BU and crown in my office is over $1100. I think our lowest plan pays in the mid 900s for both and our highest paid plan is around 1300 for both and full fee is around 1350 for FFS patients.


As far as TanMan is concerned... I probably average 25 minutes per crown prep and they look pretty good clinically, in stone, or blown up full screen on my Omnicam monitor and I feel good about my work. If I averaged 7 or 8 minutes on crown preps they would look like total crap. On the other hand I used to work for a guy that prepped crowns in one-third the time as me and his preps all looked great. I don’t know how he cut such great preps so quickly but I think it comes down to it being a talent that I do not have. I am sure all patients would prefer to have the dentist spend less time running the drill in their mouth but crown and bridge work in my hands takes more time.

I think some dentists that are either slower or average in the time it takes to make a good prep just assume that someone like TanMan is doing lower quality work but after working for a guy that seemed to be great at speed and quality I think it is possible that TanMan could be that top 1% like the guy I used to work for.

 

[charlestweed]

Although I graduated many years (twice.....more than 16 years ago) before ColdFront, I can’t afford to slow down to 3 days/week like him. I continue to work 5 days/wk because:

1. I am not as successful as Coldfront. I don’t have the right business and people skills that are necessary to run a successful business. I don’t know how to advertise. English is not my first language. I work in a very saturated market in SoCal. The only thing I am good at is I know how to keep the overhead low and pass on the low cost tx to my patients.

2. I work hard now when ortho is still good and companies like Invisalign, Direct SmileCare Club haven’t been able to put me out of business. I can’t predict what ortho will be like in the next 10 years but I am sure it won’t be as good as it is now. So why not work hard and save as much as possible now? By the time things become very bad for ortho, I am ready to retire…and I won’t have to worry about the retirement money like some of my 60-70 yo ortho colleagues who still have to work right now.

3. If something happens to me now (a serious illness or death) and I can’t work, my teenage kids will be in trouble. I need to save for them as much possible.

4. To me, at 46, it would be a big waste to only work 3 days/week and stay home doing nothing the rest of the week. “Laziness may appear attractive but work gives satisfaction.” Anne Frank.

5. I enjoy making money. To me, it can buy happiness. That's why I decided to go to dental school...and to specialize afterward.

 

[charlestweed]

I guess my point is ..... in the old days ..... working really hard often led to success. Is that still the case now? Seems like you need hard work and luck sometimes to be an outlier.

I believe that is still the case now. There are jobs available but many of the new grads (whom I have talked to on this forum and Orthotown forum) are not willing to accept the job offers for various reasons: the pay is too low, the GP offices don’t have experienced ortho assistants, the offices are too far away, don’t want to work on the weekends, the Corp offices overbook patients etc. I remember when I started ortho at a GP office, I made $0 on my first day there…..all free consults and none of the patients wanted to start tx. And now, I make more (per day) at this GP office than at the Corp office.

 

[kingme23]

I barely check these forums these days.

I would say with a good plan, Dentistry is still strong and the right profession to pursue. Ofcourse a lot depends on the dentist, ambitions, business knowledge and where he/she practices.

I have been fortunate to cut back on Dentistry a lot and put my hard earned money from 8 years in Dentistry into other businesses. During those 8 years, I opened multiple offices and bought commercial buildings, and now work 3 days a week and don’t plan to work as hard as those first 8 years in my career ever again. I went through a lot of stress, gained about 10 lbs, even triggered shingles from the stress. However, I’m happy now and have a lot of time to catch up with life and travel more. I’m turning 40 this year... and I think Dentistry has been good to me, but it came at a cost; hard work and patience.

Would I do it all over again? You bet! I believe in working towards a long term plan and gain for short term pain. I think any dentist can do what I did, but not every dentist wants to work really hard and have the patience to make it in the long.

So, yes, I still believe in Dentistry.

No doubt you must have hustled your arse off. Did you hop between a bunch of ops like our friend Tanman?

 

[321931]

No doubt you must have hustled your arse off. Did you hop between a bunch of ops like our friend Tanman?

Hopefully you guys understand....that a forum is just a very very very small minority of people that speak an opinion. Also understand that people that are successful and proud of their accomplishments...speak proud of their accomplishments. It's much different if a poster comes on board and says they still live at home with their parents...haven't paid into their principle on loans...and associates for a measly 150k in a saturated area. Or another poster comes on board and says I make the average amount as a dentist and it's hard out here.

Much easier to come on board and talk about the 2 mil practice/3 medical complexes they opened. That's great, but thats the minority. I've been out long enough to know that these people like Tanman/Cold Front are exceptional and the minority. I also am reasonable enough to know that I would never expect those kind of results after graduating dental school. Good luck boys!

 

[Cold Front]

Although I graduated many years (twice.....more than 16 years ago) before ColdFront, I can’t afford to slow down to 3 days/week like him. I continue to work 5 days/wk because:

1. I am not as successful as Coldfront. I don’t have the right business and people skills that are necessary to run a successful business. I don’t know how to advertise. English is not my first language. I work in a very saturated market in SoCal. The only thing I am good at is I know how to keep the overhead low and pass on the low cost tx to my patients.

2. I work hard now when ortho is still good and companies like Invisalign, Direct SmileCare Club haven’t been able to put me out of business. I can’t predict what ortho will be like in the next 10 years but I am sure it won’t be as good as it is now. So why not work hard and save as much as possible now? By the time things become very bad for ortho, I am ready to retire…and I won’t have to worry about the retirement money like some of my 60-70 yo ortho colleagues who still have to work right now.

3. If something happens to me now (a serious illness or death) and I can’t work, my teenage kids will be in trouble. I need to save for them as much possible.

4. To me, at 46, it would be a big waste to only work 3 days/week and stay home doing nothing the rest of the week. “Laziness may appear attractive but work gives satisfaction.” Anne Frank.

5. I enjoy making money. To me, it can buy happiness. That's why I decided to go to dental school...and to specialize afterward.

#1. I agree.

#4. I too enjoy work, but as a general dentist (and you being an orthodontist) there is a big difference. I would longer recovery period from work than an orthodontist, and with the whole long term posture risk, a general dentist body burns out sooner than orthodontist. My 3 days of work is equivalent to 5 days of work for you.

 

[Cold Front]

No doubt you must have hustled your arse off. Did you hop between a bunch of ops like our friend Tanman?

I hopped a lot. I also speak 6 languages, 3 of them very fluent. Sometimes I would say “open wide” in the wrong language to some patients, that’s how crazy it use to be.