Is ortho dying?

[futuredentist123]

Hi.

I am in dental school, and I have been eyeing ortho. My problem is that I recently shadowed an orthodontist in a suburban area, and he has less than 5 patients every couple of hours. I asked the assistant if it is always this dry, and she said yes. He also told me that he sold his practice to a DSO about 5 years ago because it was dying, and they thought they could revive it, but even with all of their marketing and other resources, the practice is still dying. The orthodontist thinks this is because of the culture and saturation of the area that his practice is in (not even a big city - a very suburban city), along with GPs doing more clear aligner cases and people having access to at-home ortho (like Smile Direct Club).

I really like ortho, but I am unsure about the future of the specialty. I also do not prefer to put in all of the work to become an orthodontist just to have to move to a remote area, hours from a big city, to have a successful practice.

What do you all think the state of ortho will be in 10 to 15 years? Will ortho look very different than it does today? Will ortho only be good for complex cases while the GPs take care of the rest? Are less and less people needing ortho treatment from an orthodontist?

I appreciate your input. I think ortho is great, and I never believed when people said it was "dying" until I saw it with my own eyes. It was sad to see, but I need to be realistic with my future and the outlook of the career I pursue.

Please keep it respectful in the thread.

Thanks!

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[chiangmai2015]

I agree that orthodontics is not as lucrative as before due to the reasons that you have mentioned. General dentists take over easy cases. Patients have access to third parties and perform DIY braces. Bigger ortho programs are opening up left and right which include Georgia School of Orthodontics (45 residents). My speculation is that within one or two decades, the orthodontics specialty may not be as popular as it is now.

 

[juniordentist]

Ortho probably has about 10-20 good years left.
So if you are an orthodontist now, you'll be ok.
If, in a predent situation, it's going to take 10 years to be an ortho, probably 15-20 to be debt free, then I think it's a gamble

 

[Thehighwind87]

Ortho, GP, imo are on their last legs. Ortho debt is just too much and the field is encroached on by GP and stuff like mail in slingers. GP has had their profits diminished due to inflation and will most likely just get worse.If you are a GP owning there is some good years left but the ones racking up debt and going into the field later 4-6 years out are prob going to have a really rough time.

Endo omfs should continue to do well overall.

Just my opinion of course.

 

[D1Bound]

Ortho, GP, imo are on their last legs. Ortho debt is just too much and the field is encroached on by GP and stuff like mail in slingers. GP has had their profits diminished due to inflation and will most likely just get worse.If you are a GP owning there is some good years left but the ones racking up debt and going into the field later 4-6 years out are prob going to have a really rough time.

Endo omfs should continue to do well overall.

Just my opinion of course.

I’ve had a retired endo tell me implants are going to be more common than a RCT. Who knows

 

[Thehighwind87]

I’ve had a retired endo tell me implants are going to be more common than a RCT. Who knows

I can see that happening. It really depends on what kind of office you are. There offices that push ext + implant all in one office, and there are offices that say lets do everything we can do to save the tooth.

It's debatable and on a person by person, location by location (high income vs middle income vs lower income). But I can see that reasoning. Regardless I still see that profession as being better off then GP/Ortho.

 

[charlestweed]

Hi.

I am in dental school, and I have been eyeing ortho. My problem is that I recently shadowed an orthodontist in a suburban area, and he has less than 5 patients every couple of hours. I asked the assistant if it is always this dry, and she said yes. He also told me that he sold his practice to a DSO about 5 years ago because it was dying, and they thought they could revive it, but even with all of their marketing and other resources, the practice is still dying. The orthodontist thinks this is because of the culture and saturation of the area that his practice is in (not even a big city - a very suburban city), along with GPs doing more clear aligner cases and people having access to at-home ortho (like Smile Direct Club).

If I opened my office 5 days/wk, 8 hours/day, I would have the same 5-6 patients every couple of hours like the orthodontist, whom you shadowed. To keep my appt book full and to keep myself busy, I book as many patients (60 patients on the weekdays and 90 patients on the weekends) in one day as possible and I only work a few days a month at each of my offices. I own 3 offices (used to be 4) and I only work 9 days a month: 6 days/month at office #1, 2 days/month at office #2 and 1 day/month at office #3. I also work 8 days/month as an associate at 2 of the corp offices to supplement my income. So I travel to 5 different offices.....for a total of 17 days/month.

A lot of orthodontists work like me. They travel to different office to keep themselves busy. Other specialists (OS, endo, perio, pedo) also have to travel. Specialists don’t get as many patients as the GPs (they don't advertise to the general public, they don't have emergency walk-ins, they rely on GP referrals etc) but they get paid very well for each of the procedures that they perform.

I really like ortho, but I am unsure about the future of the specialty. I also do not prefer to put in all of the work to become an orthodontist just to have to move to a remote area, hours from a big city, to have a successful practice.

Who doesn’t? Ortho is still one of the toughest specialties to get into. Even programs like Georgia have no problem filling all their seats. I remember after the match day, Georgia had around 15-20 unfilled positions. Now, I look at the program’s website…..41 of the available 45 seats were filled. So try to keep good grades to increase your chance of getting into a good and inexpensive program. I’ve met a lot unhappy practicing general dentists who wanted to do ortho but didn’t have good enough grades to get in.

What do you all think the state of ortho will be in 10 to 15 years? Will ortho look very different than it does today? Will ortho only be good for complex cases while the GPs take care of the rest? Are less and less people needing ortho treatment from an orthodontist?

I can’t predict the future. But for right now, the average pay for associate ortho at the corp is around $1300-1500 a day, which is almost 2x as much as when I graduated 20 years ago. My first job at the corp paid me $800/day. And there are a lot of ortho job listings on Indeed. My corp is looking for an orthodontist and they still haven’t found one for more than 5 months….I still have to drive up there 1-2 times a month to help them. I guess the reason nobody wants to take this job is it’s 80 miles away from Orange county (where I live). If you are not picky and don’t mind travel to work at different offices, there should be plenty of corp jobs available. Your income depends on the number of days you work per month. The harder you work and the more days you work, the more money you make.

I appreciate your input. I think ortho is great, and I never believed when people said it was "dying" until I saw it with my own eyes. It was sad to see, but I need to be realistic with my future and the outlook of the career I pursue.

Please keep it respectful in the thread.

Thanks!

It’s “dying” if you have your own office and don’t spend time going around to meet the referral GPs. Nobody knows who you are if you don’t spend time to introduce yourself. This is not an easy task. That’s why a lot of older orthodontists like me and the ortho, whom you shadowed, stopped doing that. And as a result, our offices have lost a lot of new patients. I had worked very hard for a long time (as many as 24 days a month at one point) and now it’s time for me to slow down. It’s time for you, the young generation, to take over.

 

[redchesus]

I’ve had a retired endo tell me implants are going to be more common than a RCT. Who knows

Maybe? I thought so too when I graduated 8 years ago. Now we're finding out that... surprise! implants come with chronic problems too, and patients are MUCH more pissed about peri-implantitis than periodontitis because they paid for it and they think YOU did something wrong

 

[Thehighwind87]

Maybe? I thought so too when I graduated 8 years ago. Now we're finding out that... surprise! implants come with chronic problems too, and patients are MUCH more pissed about peri-implantitis than periodontitis because they paid for it and they think YOU did something wrong

Totally agree. People aren't as pissed when their root canal fails...but holy moly do they get pissed when an implant fails. That's a reason why I don't place them. The more angry a patient is- the more likely they are to sue/board complaint. Just a fact of life.

Regardless, the biggest single issue with ortho is debt debt debt. I think its a great field if you have reasonable debt. If you have to go to into alot of debt, then good luck- you will need it.

 

[charlestweed]

Regardless, the biggest single issue with ortho is debt debt debt. I think its a great field if you have reasonable debt. If you have to go to into alot of debt, then good luck- you will need it.

Debt and the expensive high tech equipments (CBCT, intraoral scanner, 3D printer, computers etc) that the orthodontists rely on. Ortho used to be a very low overhead specialty. It’s not anymore….it actually costs a lot more now (more than building a GP office) to build an office from scratch. I graduated 20+ years ago. I still use the same low cost technique/equipment to treat my patients. I haven’t upgraded anything…..still use the same 17 yo film based pan/ceph machine. That’s why my overhead is in the mid 30%…..brackets and wires are very cheap.

 

[Thehighwind87]

Debt and the expensive high tech equipments (CBCT, intraoral scanner, 3D printer, computers etc) that the orthodontists rely on. Ortho used to be a very low overhead specialty. It’s not anymore….it actually costs a lot more now (more than building a GP office) to build an office from scratch. I graduated 20+ years ago. I still use the same low cost technique/equipment to treat my patients. I haven’t upgraded anything…..still use the same 17 yo film based pan/ceph machine. That’s why my overhead is in the mid 30%…..brackets and wires are very cheap.

Wow that's a pricey picture- cbct, scanner, printer,...and you prob need a big office footprint for volume. How much would a "newer" practice with a decent footprint/cbct/scanner/printers cost- cuz I know ballpark for a new 5 op office GP is probably low end 400k to middle of the road 500k. And that was back in the 2010s.

 

[fantasticflossophy]

(Disclaimer: I am not a dental student yet -- starting in the fall. So, my thoughts may just be gibberish.)

I think location matters a lot. Where you are practicing influences the type of patients you attract and what their aims are. I've lived in a small town (population 23,000) for 12 years and have shadowed my "orthodontist" (general dentist with orthodontic CE) extensively. He is extremely successful. He never experiences patient drought. Everybody in the 40 mile radius wants him to do their braces. This dentist is booked for ages and could have retired 8 years ago, but still chooses to work because he wants to serve the community.

Being in the suburbs or city, a dentist may experience more of a patient drought because of so many other practices being available. And with Yelp and Google Reviews being the average person's go-to before choosing a restaurant or dentist, they want to choose the most attractive choice. Practices touting terms like 'Aesthetics,' 'Luxury,' and 'Quick and Effective' may attract this type of suburban / city population -- simply because these communities are more advanced and have the ability to focus on the 'glam' factor of dentistry.

In comparison, a simple town like mine and the 10 surrounding ones just want to get their teeth fixed. They are way too simple to consider any 'glam' factor or even think about getting aligners online in the mail, simply because they are still living in the 90's (not a bad thing -- actually many folks around here enjoy this) and have not heard about options like that. In fact, having traditional wire braces here is like an adolescent rite of passage.

In a small town, there is no choice. There are 1-3 dentists and everybody goes to them. Hence, they are always able to do well because the culture of their patient population is 1) simple, 2) oblivious or averse to other options than the traditional, and 3) have nowhere else to go.

So the orthodontist you shadowed is right in thinking their practice is dry because of the culture and saturation of the area that his practice is in.

(Opinionated) Moral of the story: Avoid suburbs at all costs. I would give my sincere advice to any orthodontist to practice in a small town. You will be the star orthodontist of the town and everybody is basically going to love you.

 

[Solostr8]

Just built out a 2580 sq. Ft space in a renovated building and signed a 10 year lease agreement. Including new chairs/carts/lights, computers, low voltage cabling, architects fees, new air compressor, vistapure, signage, construction/contractor fees/permits etc, it was $520,000. I have. Digital pan/ ceph, and optical scanner from before, but everything else was new (water softener from old office).

My rent doubled, new landlords are jerks.
Love my new office, though! Wish I was much busier, but it's always been that way (rural practice, 3 satellite locations). I could fill my 8 free days with other stuff, but I like having flexibilty/room in my schedule, and I am 50 years old so it's ok

 

[Solostr8]

(Disclaimer: I am not a dental student yet -- starting in the fall. So, my thoughts may just be gibberish.)

I think location matters a lot. Where you are practicing influences the type of patients you attract and what their aims are. I've lived in a small town (population 23,000) for 12 years and have shadowed my "orthodontist" (general dentist with orthodontic CE) extensively. He is extremely successful. He never experiences patient drought. Everybody in the 40 mile radius wants him to do their braces. This dentist is booked for ages and could have retired 8 years ago, but still chooses to work because he wants to serve the community.

Being in the suburbs or city, a dentist may experience more of a patient drought because of so many other practices being available. And with Yelp and Google Reviews being the average person's go-to before choosing a restaurant or dentist, they want to choose the most attractive choice. Practices touting terms like 'Aesthetics,' 'Luxury,' and 'Quick and Effective' may attract this type of suburban / city population -- simply because these communities are more advanced and have the ability to focus on the 'glam' factor of dentistry.

In comparison, a simple town like mine and the 10 surrounding ones just want to get their teeth fixed. They are way too simple to consider any 'glam' factor or even think about getting aligners online in the mail, simply because they are still living in the 90's (not a bad thing -- actually many folks around here enjoy this) and have not heard about options like that. In fact, having traditional wire braces here is like an adolescent rite of passage.

In a small town, there is no choice. There are 1-3 dentists and everybody goes to them. Hence, they are always able to do well because the culture of their patient population is 1) simple, 2) oblivious or averse to other options than the traditional, and 3) have nowhere else to go.

So the orthodontist you shadowed is right in thinking their practice is dry because of the culture and saturation of the area that his practice is in.

(Opinionated) Moral of the story: Avoid suburbs at all costs. I would give my sincere advice to any orthodontist to practice in a small town. You will be the star orthodontist of the town and everybody is basically going to love you.

I can tell you that the utilization of orthodontic services is much lower in rural areas which will certainly mean lower income. This is true even if you go to multiple locations. It's not a simple ratio of population of potential orthodontic patients to number of doctors practicing.

 

[OncePreDent]

I would agree; I think the ortho specialty, in the long run will not be as popular nor as practical. I have shadowed numerous amount of orthodontists & practically all of them recommended becoming a pediatric dentist over becoming an orthodontist.

The practices I've shadowed are significantly larger practices (seeing 80-120 patients a day - 1 doctor). Most practices aren't this way, from what I understand. The orthos that I've talked to said to become a PD & do ortho. Because of what was said above & "it's like shooting fish in a barrel" to sign people up to do orthodontic work if you are a PD. Some orthos said skip ortho residence, come work for me & I'll teach you everything you need to know (waste of time & money going to ortho residency). If you are working for someone as an orthodontist, your income will range from $200k-$500k (extremely rare to be in the $500k area working for someone). Compared to other specialties like OS $500K-$600k is very normal & safe/no worry in the long run (20 years+).

I believe aligners & AI tech will become better and easier for GD to use, which will continue to eat away at orthodontists' production/income. IMO, ortho is the worst specialty you can choose today for income/job security. 20-30 years ago, the best specialty for lifestyle. If I were you and wanted to specialize, I would be open to other specialties. I myself have been the most interested in ortho, I have been since high school. Additionally, I have an incredible background in ortho and would be able to graduate and take over an ortho practice. But going into dental school, I am going to be extremely open to the possibility of pedio & more recently OS. Because, in the long run, it might be more practical.

 

[charlestweed]

Wow that's a pricey picture- cbct, scanner, printer,...and you prob need a big office footprint for volume. How much would a "newer" practice with a decent footprint/cbct/scanner/printers cost- cuz I know ballpark for a new 5 op office GP is probably low end 400k to middle of the road 500k. And that was back in the 2010s.

Probably the same as a GP office (in construction cost) + the outrageous cost of the CBCT and other modern ortho equipments, which IMO, are unnecessary. You can still provide excellent treatments without those expensive toys. The treatment outcomes depend on the doctor’s clinical experience and the number of cases that he/she started and finished. It’s the painter, not the paintbrush. The problem is the ortho residents are trained with these modern equipments and therefore, they can’t work without these toys when they get out.

In 2018 (not 20 years ago), I built my 7 op 1700sf office for only $55k. It’s actually $65k but I got $10k tenant improvement from the landlord. I relocated my office because I had some conflicts with the previous landlord. It’s cheap because the space was an existing medical office and I converted it to an ortho office. $55k was the total cost. I moved all the equipments and chairs to the new office. I didn’t buy anything new for office. Here are the before and after photos. Sorry, I had to block out my office’s logo behind the receptionist’s desk.

 

[OncePreDent]

In 2018 (not 20 years ago), I built my 7 op 1700sf office for only $55k. It’s actually$65k but I got $10k tenant improvement from the landlord. I relocated my office because I had some conflicts with the previous landlord. It’s cheap because the space was an existing medical office and I converted it to an ortho office. $55k was the total cost. I moved all the equipments and chairs to the new office. I didn’t buy anything new for office. Here are the before and after photos. Sorry, I had to block out my office’s logo behind the receptionist’s desk.

Wow, that's extremely impressive to build an office up for only $65k

 

[bracketbuster68]

I would go endo or omfs

 

[OncePreDent]

I would go endo or omfs

No endo for me, but think it's a great specialty. But curious, why not pedio?

 

[bracketbuster68]

No endo for me, but think it's a great specialty. But curious, why not pedio?

I guess it depends on your personality. Anesthesia is actually another great specialty. It could even be the best one going forward.

 

[OncePreDent]

I guess it depends on your personality. Anesthesia is actually another great specialty. It could even be the best one going forward.

I agree; I think a dental anesthesiologist is one of the best ones out there, right next to omfs. It might be better than omfs because it is much easier on your body and income.

 

[charlestweed]

You can make good money in any specialty (in general dentistry as well), if you can get the patients to come in and accept your recommended treatments. To get paid in dentistry, you have to sit down and perform the procedures. The more patients you are able to attract (and treat), the more money you make. The hard part is to get patients. Your success as a specialist depends on the relationship that you have with the referrals GPs. If you don’t have good communication and are unable to keep the GPs happy, then your only option is to travel to work at multiple offices.

 

[DustFreeEraser]

No endo for me, but think it's a great specialty. But curious, why not pedio?

Increased supply of pedodontists + decrease in birth rate

 

[AONLINE]

No endo for me, but think it's a great specialty. But curious, why not pedio?

You mean perio or pediatrics?

 

[Thehighwind87]

No endo for me, but think it's a great specialty. But curious, why not pedio?

Pediatrics is incredibly tough. I am amazed that anyone can do pediatrics.

Probably the same as a GP office (in construction cost) + the outrageous cost of the CBCT and other modern ortho equipments, which IMO, are unnecessary. You can still provide excellent treatments without those expensive toys. The treatment outcomes depend on the doctor’s clinical experience and the number of cases that he/she started and finished. It’s the painter, not the paintbrush. The problem is the ortho residents are trained with these modern equipments and therefore, they can’t work without these toys when they get out.

In 2018 (not 20 years ago), I built my 7 op 1700sf office for only $55k. It’s actually $65k but I got $10k tenant improvement from the landlord. I relocated my office because I had some conflicts with the previous landlord. It’s cheap because the space was an existing medical office and I converted it to an ortho office. $55k was the total cost. I moved all the equipments and chairs to the new office. I didn’t buy anything new for office. Here are the before and after photos. Sorry, I had to block out my office’s logo behind the receptionist’s desk.
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That's actually really amazing. Good job. I want to do this when my lease runs out in 2030. I'll be shopping around 2027-29. I was worried that going into a new space would cost 500k.... but this looks like a great alternative. I would be hard pressed to renew my lease as its a 3% rate of increase and with reimbursement decreasing and inflation persistent- I just can't stomach losing more money year over year to a lease that is non-negotiable. My rent literally increases a few hundred dollars every year. Since I took over, my lease has increased more then 1k+. By the time I renew it will be 2k+ and by the end of that renewal 3k+. All the while reimbursement probably stagnates or decreases.

Either I move, sell the practice, or close up shop.

 

[OncePreDent]

Increased supply of pedodontists + decrease in birth rate

Couldn't you say that for anything in dentistry? Increased supply of all specialties + GD & decrease in birth rate

 

[OncePreDent]

You mean perio or pediatrics?

Sorry, pediatrics*

 

[DustFreeEraser]

Couldn't you say that for anything in dentistry? Increased supply of all specialties + GD & decrease in birth rate

Could you? I wasn't aware a lot of endo/omfs programs have opened or expanded enrollment compared to pediatrics in the last 10-15 years.

And if you're interested and pedo and OK being paid similar to general dentistry (which it already is at saturated cities), it'd be prudent for you to hope the number of post match spots available for pedo this year was an anomaly and not a trend

 

[D1Bound]

Could you? I wasn't aware a lot of endo/omfs programs have opened or expanded enrollment compared to pediatrics in the last 10-15 years.

And if you're interested and pedo and OK being paid similar to general dentistry (which it already is at saturated cities), it'd be prudent for you to hope the number of post match spots available for pedo this year was an anomaly and not a trend

That’s a good point. Have any new endo or OS programs opened lately? I’m asking

 

[OncePreDent]

Could you? I wasn't aware a lot of endo/omfs programs have opened or expanded enrollment compared to pediatrics in the last 10-15 years.

And if you're interested and pedo and OK being paid similar to general dentistry (which it already is at saturated cities), it'd be prudent for you to hope the number of post match spots available for pedo this year was an anomaly and not a trend

Yes, you absolutely can. @D1Bound The University of Utah is planning to open another OMFS program, currently looking for an OS to create/run it. I'm not sure about how it compares to pediatrics overall, but there are programs that have been expanding or developing new programs. Either way, new programs or expansions are happening for most, if not all specialties.

As you know, there will always be more and more schools opening up for every specialty. As long as the specialty programs generate income for schools, they will want to add them. From what I understand, ortho is the specialty that generates the most income for dental schools per student (source: ortho faculty). Who knows if that is true or only for that dental school. But just like we continue to see, dental schools popping up everywhere. I am sure we will continue to see dental schools expanding or developing specialty programs because it is another source of income for them.

 

[DustFreeEraser]

Dental Match | Statistics of the Match

natmatch.com

Not included is 2012-2013 but positions offered went from 343 in 2012-2013 to 362 in 2013-2014 for pedo while omfs went from 217 to 223.

If you are open to any specialty and you have time to prepare, I'd recommend one with the highest entry to barrier, i.e. omfs, delay gratification, and reap the reward.

 

[OncePreDent]

Dental Match | Statistics of the Match

natmatch.com

Not included is 2012-2013 but positions offered went from 343 in 2012-2013 to 362 in 2013-2014 for pedo while omfs went from 217 to 223.

If you are open to any specialty and you have time to prepare, I'd recommend one with the highest entry to barrier, i.e. omfs, delay gratification, and reap the reward.

Thanks for sharing this, extremely helpful

 

[sbh4096]

Could you? I wasn't aware a lot of endo/omfs programs have opened or expanded enrollment compared to pediatrics in the last 10-15 years.

And if you're interested and pedo and OK being paid similar to general dentistry (which it already is at saturated cities), it'd be prudent for you to hope the number of post match spots available for pedo this year was an anomaly and not a trend

Pedo here. The statement you made is misleading. Pedo get paid about 2x more than GP in terms of base salary. As an associate in a busy practice, you can easily make more if you are fast and efficient. If you perform big cases under general anesthesia, your earning potential would be even higher. I work in a saturated city metro and my daily pay is just about same as ortho, sometimes more on busy days. There are way more demand(tons of pediatric patients in needs of care) than supply.

 

[DustFreeEraser]

I'm speaking more towards people that are starting dental school or in dental school now and giving an estimate of what could happen in the future. For someone starting this upcoming year, that's at least 2029 that they will start working as a pedo.

The specialty is adequate but for a pre-dent or a D1, it is good to consider what the trends are, especially when you have the time to choose. Not everyone has to have a passion for a job/specialty/field/career and are able to choose a field based on what they can tolerate. Aim for the hardest road possible and you can always fall back to something relatively less arduous.

And it's good to take opinions with a grain of salt especially when someone is promoting their own field as being objective is not an easy task for anyone.

 

[futuredentist123]

Some orthos said skip ortho residence, come work for me & I'll teach you everything you need to know (waste of time & money going to ortho residency).

How would I find an orthodontist that would want me, as a general dentist, to work for them?

 

[FutureDent020]

Some orthos said skip ortho residence, come work for me & I'll teach you everything you need to know (waste of time & money going to ortho residency).

Man, so many red flags with this philosophy. Whole point of residency is to give you the knowledge to treat the hardest and most complicated cases. To have answers and treatment options when others do not. To give you the tools to think out of the box. To charge specialty rates to be rewarded for your quality. You’ll just be an anecdotal Ortho monkey working for an Ortho as a GP. You’ll know some basic stuff, but you wouldn’t be able to think through complicated situations until you saw them enough and gained experience. But it could take a long time trying to learn like that in a fast pace real life environment. And can you legally charge specialty rates if you are a GP providing the care? Would the orthodontist be paying you significantly less than a Ortho associate? That sounds sketchy.

 

[Thehighwind87]

Man, so many red flags with this philosophy. Whole point of residency is to give you the knowledge to treat the hardest and most complicated cases. To have answers and treatment options when others do not. To give you the tools to think out of the box. To charge specialty rates to be rewarded for your quality. You’ll just be an anecdotal Ortho monkey working for an Ortho as a GP. You’ll know some basic stuff, but you wouldn’t be able to think through complicated situations until you saw them enough and gained experience. But it could take a long time trying to learn like that in a fast pace real life environment. And can you legally charge specialty rates if you are a GP providing the care? Would the orthodontist be paying you significantly less than a Ortho associate? That sounds sketchy.

With the way dentistry is heading- there is no real point in offering specialty services as a GP. The reimbursement makes it not worth it. I stopped doing all specialty services endo-omfs-ortho when I crunched the numbers and I realized that the liability, time and effort makes it not worth it.

That is why specializing does make sense (unless you are tacking on 200-300k on top of 500k student loans- then that's just bad finances) as you can charge specialty rates and make it worth your time.

 

[redchesus]

Man, so many red flags with this philosophy. Whole point of residency is to give you the knowledge to treat the hardest and most complicated cases. To have answers and treatment options when others do not. To give you the tools to think out of the box. To charge specialty rates to be rewarded for your quality. You’ll just be an anecdotal Ortho monkey working for an Ortho as a GP. You’ll know some basic stuff, but you wouldn’t be able to think through complicated situations until you saw them enough and gained experience. But it could take a long time trying to learn like that in a fast pace real life environment. And can you legally charge specialty rates if you are a GP providing the care? Would the orthodontist be paying you significantly less than a Ortho associate? That sounds sketchy.

It sounds like this ortho wants someone to take over the easy cases but rather than hiring a fresh ortho grad they want to go even cheaper and pay GP rate (under the guise of mentorship)

 

[OncePreDent]

It sounds like this ortho wants someone to take over the easy cases but rather than hiring a fresh ortho grad they want to go even cheaper and pay GP rate (under the guise of mentorship)

Yes, that is one way that they are doing that. Additionally, I have heard of pediatric dentists in Washington hiring dental therapists for less expensive labor. Over in the UK they actually have orthodontic therapists; I wouldn't be surprised if the US will have that eventually. The DSOs would love way less expensive labor.

 

[011110]

Man, so many red flags with this philosophy. Whole point of residency is to give you the knowledge to treat the hardest and most complicated cases. To have answers and treatment options when others do not. To give you the tools to think out of the box. To charge specialty rates to be rewarded for your quality. You’ll just be an anecdotal Ortho monkey working for an Ortho as a GP. You’ll know some basic stuff, but you wouldn’t be able to think through complicated situations until you saw them enough and gained experience. But it could take a long time trying to learn like that in a fast pace real life environment. And can you legally charge specialty rates if you are a GP providing the care? Would the orthodontist be paying you significantly less than a Ortho associate? That sounds sketchy.

I’ll play Devils advocate here. Ortho residency will essentially teach you theory and what to apply in practice for sure. You’ll get a base of experience. As most orthodontists will tell you, the real learning comes after residency in practice. Repetition by doing. A fast paced environment of ortho day in day out will teach you a lot about efficiency. Just like anything in life- the more you see, the more you do, the more you learn.

Now on the flip side. Why would an orthodontist hire you? More often than not they can hire another chairside assistant to do the work. They wouldn’t really need a GP in the office, no need for one. If they are going to pay you lower then they would an ortho associate they might as well just hire a chairside assistant. That’s why these mentorships in ortho don’t happen.

@charlestweed @2TH MVR

 

[OncePreDent]

Man, so many red flags with this philosophy. Whole point of residency is to give you the knowledge to treat the hardest and most complicated cases. To have answers and treatment options when others do not. To give you the tools to think out of the box. To charge specialty rates to be rewarded for your quality. You’ll just be an anecdotal Ortho monkey working for an Ortho as a GP. You’ll know some basic stuff, but you wouldn’t be able to think through complicated situations until you saw them enough and gained experience. But it could take a long time trying to learn like that in a fast pace real life environment. And can you legally charge specialty rates if you are a GP providing the care? Would the orthodontist be paying you significantly less than a Ortho associate? That sounds sketchy.

I would say yes and no. Ethically it doesn't make any sense. However, it does happen. An orthodontist told my brother to shadow a different orthodontist in the state that my brother was living in. The office was called Smile Orthodon"tics"(fake name). However, when my brother was shadowing this supposed orthodontist, he found out that the ortho never did an orthodontic residency & was actually a general dentist solely performing orthodontic treatment. So yes, you can take the continuing education or do a make-shift private fellowship and still preform orthodontic treatment.

From what the orthos have told me about residencies vs non-residency routes to ortho.
The one's that were against doing the residency were saying how you can learn significantly more working in a clinic than in school. The ortho schools they went to were teaching outdated techniques in orthodontics. They didn't teach anything about expanders and other techniques that they needed to learn outside of their residency. Additionally, the time & cost of orthodontic programs (mainly the 2-3 years you lose).

The one's that were for it felt like it would be beneficial to have the MS or certificate in ortho. That way you are able to say you are an orthodontist not Dr. _____ providing orthodontics. I should note that I am planning to have my own clinic as well & I think another huge benefit to going to a residency are for people who are going to work as an Ortho for DSOs or corporate. There is no way a DSO or corporate is going to hire someone that is a GD to act as an Ortho.

 

[OncePreDent]

How would I find an orthodontist that would want me, as a general dentist, to work for them?

I think it would be difficult to find. I am fortunate to have some family-friends that have specialized and became orthos. While shadowing them and talking to them they would ask me if I was interested in ortho & would tell me to skip the residency and learn from them. They all have their own private practices & were trying to pursue me to have my own as well. Note: I've shadowed 9+ different orthodontists, and only 2 of them said this. One of them was very hardcore against going to orthodontic residency, though, and keeps pushing me to learn how to run a practice and ortho from him.

Do you have any really good relationships with any orthos out there?

 

[011110]

I’ll play Devils advocate here. Ortho residency will essentially teach you theory and what to apply in practice for sure. You’ll get a base of experience. As most orthodontists will tell you, the real learning comes after residency in practice. Repetition by doing. A fast paced environment of ortho day in day out will teach you a lot about efficiency. Just like anything in life- the more you see, the more you do, the more you learn.

Now on the flip side. Why would an orthodontist hire you? More often than not they can hire another chairside assistant to do the work. They wouldn’t really need a GP in the office, no need for one. If they are going to pay you lower then they would an ortho associate they might as well just hire a chairside assistant. That’s why these mentorships in ortho don’t happen.

@charlestweed @2TH MVR

There are also a couple reasons as to why it is hard for GPs to get good and efficient at ortho
1. Treatment length. It’s not like doing an implant. Doing ortho correctly takes time and to learn from your progress photos. Without getting a job working as ortho doing it day in and day it is very hard to learn.
2. Cases. Doing a few cases here or there makes it tough to learn. You need to be fully immersed in ortho to become proficient, efficient, and profitable. Its very hard to be all 3 in a GP practice especially if you don’t have the case volume to learn from.
Again, most of your learning is not done in an ortho residency. But it does give you a springboard to get a full time ortho job after residency where most of your learning will occur.

 

[redchesus]

There is no way a DSO or corporate is going to hire someone that is a GD to act as an Ortho.

Actually there are DSOs out there whose business model is to have one orthodontist oversee 4-5 GDs doing ortho treatment. That way they can say an orthodontist has approved the treatment plan, but in reality it's mostly the GDs doing the work. So it sounds similar to the set-up you had described.

 

[OncePreDent]

Actually there are DSOs out there whose business model is to have one orthodontist oversee 4-5 GDs doing ortho treatment. That way they can say an orthodontist has approved the treatment plan, but in reality it's mostly the GDs doing the work. So it sounds similar to the set-up you had described.

Interesting, I didn't know that DSOs were doing that too. Guess that is another path a GD can do ortho if they are interested.

 

[charlestweed]

I’ll play Devils advocate here. Ortho residency will essentially teach you theory and what to apply in practice for sure. You’ll get a base of experience. As most orthodontists will tell you, the real learning comes after residency in practice. Repetition by doing. A fast paced environment of ortho day in day out will teach you a lot about efficiency. Just like anything in life- the more you see, the more you do, the more you learn.

Now on the flip side. Why would an orthodontist hire you? More often than not they can hire another chairside assistant to do the work. They wouldn’t really need a GP in the office, no need for one. If they are going to pay you lower then they would an ortho associate they might as well just hire a chairside assistant. That’s why these mentorships in ortho don’t happen.

@charlestweed @2TH MVR

That’s correct. I can just hire more ortho assistants to help me. I don’t trust anyone (not even another orthodontist) to touch my patients without my supervision. I have to preserve the reputation that I have built over the years. I have to take good care of my patients in order to continue to get more referrals from my referring dentists and from my patients.

 

[charlestweed]

The one's that were for it felt like it would be beneficial to have the MS or certificate in ortho. That way you are able to say you are an orthodontist not Dr. _____ providing orthodontics. I should note that I am planning to have my own clinic as well & I think another huge benefit to going to a residency are for people who are going to work as an Ortho for DSOs or corporate. There is no way a DSO or corporate is going to hire someone that is a GD to act as an Ortho.

There are a lot of benefits of having an ortho certificate. That’s why many general dentists (and some pedodontists as well), who have done a lot of ortho cases in their practices, still want to go back to school to specialize in ortho. That’s why ortho is still a very competitive specialty to get into. That’s why many sons and daughters of the orthodontists don’t just stop at being GPs (and just learn to do ortho from their orthodontist parents)….they want to become orthodontists and take over their parents’ practices. That’s why expensive programs like Georgia, NYU, USC don’t have any problem filling their seats.

Having an ortho certificate allows you to get high paying jobs (jobs that pay 2-3x more than what an associate GP makes) at the DSOs and at private offices. Another benefit is you can advertise your practice “limited to orthodontics” and are able to gain referrals from different GP offices. GPs won’t refer ortho cases to another GP. Being a GP limits him/her from getting enough ortho cases to keep him/herself busy. Most GPs who do ortho have to do other general dental procedures in order to fill the appointment book.

 

[HMI]

That’s why expensive programs like Georgia, NYU, USC don’t have any problem filling their seats.

The reason these programs don't have any problem filling up their programs is because there are lots of naive pre-dents who do not know what the ROI is going to be and think they can have the life of a dentist / specialists that came out 30 yrs ago when the student loan was fraction of what it is now, cost of ownership was lower, you didn't have to pay $20+ per hour for someone just to hold the suction for you, there were no corporations, cost of living and owning home was significantly lower,...

other reason is the burned out / hopeless GPs out there that are seeing the profit shrinking after covid, cost going up,... and think the way out is more debts ( I am in contact with two of my classmates that did ortho and both complain, mainly saying GPs do not refer)

Dentistry as a profession is not worth it anymore, I honestly don't care enough to type all the reasons but my son for one will not be a dentist (maybe a physician if he has the interest), but there are better professions out there that will not get you in $500K+ in debt for a degree ($700-800K with specializing and probably close to $1M if you end up doing all of it at one of these for profit schools) and you don't need to invest as many years to learn these profession. I see so many stressed, broke dentists (and pharmacists) now living paycheck to paycheck (I'm in southern CA so maybe that's one reason). Unless you are coming from a rich family that your parents could cough up money to cover your tuitions and hand you a practice, then good luck. I don't like this profession and can't wait to get out, but I'm happy I'm not going to dental school now, it is significantly harder now compared to when I came out (10 yrs ago), and I've owned 3 practices, down to 1 now but I am opening another one because honestly at best my current one can only keep me busy for 3days/week (it was busier in 2019 when I opened it but now it's harder to fill the schedule so I have to go back to 6 days/week between 2 practices to keep myself busy (at least that's the idea). So now, I have to go in more debts and work more to stay afloat.

Anyway, best of luck to hopeful dentists/pre-dents, but take the whole advice of "you can pay it back, work harder, see more patients,..." with a grain of salt; there are too many dentists being produced (GPs and specialists), new dental schools popping up, when the supply is high the value goes down and that's exactly what I'm seeing. You have to sell your crown lower to compete with the other dentist that sells it lower (a race to the bottom), PPO INS can keep their fees flat or lower them because there are too many dentist that have no choice but to accept it, medicaid will pay you 40% of your fees because 40% of population are on it and you have no choice but to take it to stay somehow busy (not too busy). and not everybody going to be a superstar dentist, and you can't work harder and make. more if you don't have enough demand/patients walking through your doors.

 

[gryffindor]

This specialty is very clean compared to OMFS. It's peaceful compared to Pedo. More visual and lively compared to Endo. Much less hands-on compared to Perio and Prostho.

Is it worth it? If you're willing to join the 6-days-a-week club, you can probably knock down a large chunk of the loans quickly. Most new grads I meet don't want to join this club. Ownership has its own headaches. If you can find a profitable and established practice to buy, you will have a leg up but there aren't nearly as many practices going on the market as DSOs poach the formerly good practices.

There is a lot of ortho out there to be done, but it's not as easy as it was to capture those easy class 1 mild crowding cases from the past. A lot of those cases are at the pediatric dentist who hires an orthodontist to not lose the revenue. That means we are seeing the much harder cases which still is fine because the alternative of doing any of the other specialties I listed above would be a no-go at this point.

I can't heartily recommend dentistry to new grads though anymore. Those who are already in dental school and want to ask me about being an orthodontist, I'd have to ask them to be honest with me about their debts and ideal work schedule and future outlook in life (married? kids? location?) to figure out if specializing will be worth it. I don't know about specializing in pedo for someone who really wants ortho. Maybe if you can own and run a prophy palace and hire others to do the actual restorative. That would be a clean career like ortho.

 

[Thehighwind87]

The best way I would describe dentistry pre Covid is like running a hamster wheel on a flat surface. You can run as fast as possible etc but it’s just sorta futile.

After Covid, it feels like you are in a hamster wheel but on an 10-20% incline.

That’s if you are a currently practicing dentist.

Now if you are a new dentist 1-3 years in or about to enter the workforce:

I would describe your future experience as crossing the Atlantic Ocean from America to Europe on a rowboat to get onto a hamster wheel on a 50% incline.

Dentistry isn’t getting any easier. It has everything against it- and no tailwinds behind it.

Eventually you learn to get off the hamster wheel and retire, but every year it gets harder. Regardless dentistry has been good to me. I would just tell people that it’s def a harder profession overall today and there are prob easier routes in life.