Is Perio Residency worth another 400k?

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SnowDent98

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Hi docs,
I matched into a perio program that costs 400k for 3 years (currently already have $400k in debt for dental school.) Previously not a smart kid and got a master degree for $100k to get into dental school. Total i’m looking at $900k at least after the residency. Any thoughts on job prospect of perio?
Thank you.
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Yikes.

No job is worth 900k in debt
 
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For future applicants, not just for dentistry but for any careers, it is not a bad idea to think about the 5/10/25 year outlook of a job/specialty beforehand.
 
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SnowDent98 said:
Total i’m looking at $900k at least after the residency.
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With 3 years of accrued interest, you’ll likely be north of $1,000,000. You comfortable with that? After you graduate, you’ll need to pay around $70,000/year just to cover the interest on your loans, let alone pay down the principal. And that will be paid with after tax money, so you’ll need to earn $95,000/year JUST TO KEEP YOUR LOANS FROM SNOWBALLING.

I would not be going to residency if I were you.

Let this be a lesson to other SDNers who are so focused on getting into dental school or residency that they never stop to ask if they should.

Big Hoss
 
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Isn't this a question you should have asked before applying? Now that's you've matched, you're in a tough position because you can't back out without some serious repercussions.
 
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Absolutely criminal price tag
 
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Congratulations on matching! Personally, I would not get into so much debt but I also don’t know your family situation. I would not want to spend my life paying loans and interest when you also need to buy a house, go on a nice vacation once in a while, buy some other nice things for yourself and your spouse, provide for your kids (when you’ll have them). Real life dentistry is tough and periodontists earn good money if they have exceptional skills and have a good network of dentists they work with. It takes time to build exceptional skills. If during specialty training you do 5 external sinus lifts and place 60 implants, that’s really not worth it for so much money. I’m not sure even ortho is worth going into so much debt. Probably OMFS is, but that requires a lot of commitment and sacrifices vs perio or any other specialty.
 
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emma_m said:
Congratulations on matching! Personally, I would not get into so much debt but I also don’t know your family situation. I would not want to spend my life paying loans and interest when you also need to buy a house, go on a nice vacation once in a while, buy some other nice things for yourself and your spouse, provide for your kids (when you’ll have them). Real life dentistry is tough and periodontists earn good money if they have exceptional skills and have a good network of dentists they work with. It takes time to build exceptional skills. If during specialty training you do 5 external sinus lifts and place 60 implants, that’s really not worth it for so much money. I’m not sure even ortho is worth going into so much debt. Probably OMFS is, but that requires a lot of commitment and sacrifices vs perio or any other specialty.
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One huge advantage of OS residency- basically no additional debt except if you do medical school.
 
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My main man @bigtimehoosier is right. He’s a pillar of this community I would listen to him. No but seriously, think about staring down the barrel of 1 MILLION dollars. That’s just nutty. Unless you instantly started slamming tons of All On Four cases the second you graduated, you couldn’t hope to take care of your debt. Being a periodontist is not cool enough to have a ball and chain of debt attached to your ankle for years upon years.
 
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D1Bound said:
He’s a pillar of this community I would listen to him.
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3B0C835A-4FEE-43BE-8D59-D0D7BF8F1FD3.gif


Big Hoss
 
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SnowDent
You are already running the wrong way on the on the dental financial highway.
Do not, I repeat, DO NOT go any farther down that debt path.
It is time to turn around and start making money!
 
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Keep in mind that when you back out of this match, you will never be able to participate in the match again if you decide to go back to school to specialize in the future.

It’s much harder to get patients (and jobs) for perio than for other other specialties like ortho, os and pedo. There are not a lot of corp offices that hire perio…..and the ones that do only hire you 1-2 days a month. To get full time work schedule you have to travel to multiple offices. In her early career, my wife, who is a perio, had had to travel to as many as 9 different offices.

To be successful in perio, you have to be able to do a wide range of procedures (in addition to the basic perio procedures like osseous surgeries, connective tissue graft, crown lenghtening etc) like 3rd molar extractions, canine exposures, sinus lifts etc. You cannot just be good at implant placements but you need to be good at implant restorations as well so you can teach the referring GPs and help them with the implant tx planning. Your clinical skills and ability to communicate with the referring GP are both very important in getting patients. No patient = no money = can’t pay back the loans. Unfortunately, most perio programs only teach you simple surgical procedures that are limited to perio.

So if you are willing to do whatever it takes to earn the trust from your referral GPs….and from your GP bosses (if you do in-house perio for them), you will do very well and should have no problem paying back your $900k debt. My wife makes more per day than what I make. The reason my income is higher is my wife doesn’t have enough patients to work full time like me. Both of my wife’s former co-residents make way more than us. If you are a shy person like me and hate to talk to the GPs, then I don’t think perio is for you.
 
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voxveritatisetlucis said:
Is OMFS the only dental residency that doesn’t charge?
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51 percent of the omfs programs/residency spots for omfs is single degree/four year. 49 percent is dual degree/6 year.

In four year omfs programs you are not charged any tuition. You are also paid 50-60 k a year by the residency department/ hospital during the four years.

In six years programs you are also paid a stipend for part of the residency. Some medical schools charge tuition. I have some close friends who went to dual degree programs and have graduated with a seven figure debt.
 
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charlestweed said:
Keep in mind that when you back out of this match, you will never be able to participate in the match again if you decide to go back to school to specialize in the future.

It’s much harder to get patients (and jobs) for perio than for other other specialties like ortho, os and pedo. There are not a lot of corp offices that hire perio…..and the ones that do only hire you 1-2 days a month. To get full time work schedule you have to travel to multiple offices. In her early career, my wife, who is a perio, had had to travel to as many as 9 different offices.

To be successful in perio, you have to be able to do a wide range of procedures (in addition to the basic perio procedures like osseous surgeries, connective tissue graft, crown lenghtening etc) like 3rd molar extractions, canine exposures, sinus lifts etc. You cannot just be good at implant placements but you need to be good at implant restorations as well so you can teach the referring GPs and help them with the implant tx planning. Your clinical skills and ability to communicate with the referring GP are both very important in getting patients. No patient = no money = can’t pay back the loans. Unfortunately, most perio programs only teach you simple surgical procedures that are limited to perio.

So if you are willing to do whatever it takes to earn the trust from your referral GPs….and from your GP bosses (if you do in-house perio for them), you will do very well and should have no problem paying back your $900k debt. My wife makes more per day than what I make. The reason my income is higher is my wife doesn’t have enough patients to work full time like me. Both of my wife’s former co-residents make way more than us. If you are a shy person like me and hate to talk to the GPs, then I don’t think perio is for you.
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thank you for the reality check.
 
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SnowDent98 said:
Hi docs,
I matched into a perio program that costs 400k for 3 years (currently already have $400k in debt for dental school.) Previously not a smart kid and got a master degree for $100k to get into dental school. Total i’m looking at $900k at least after the residency. Any thoughts on job prospect of perio?
Thank you.
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no way
 
Absolutely not. Watch this video. Theres a periodontist with 1 million post training who is working and feeling trapped paying > $6000 month, INTEREST ONLY! Stop going into more debt expecting your salary to be the cushion.
 
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So out of curiosity, what would be the best course of action if the op now decides to not continue with the residency? Is it possible to withdraw at this point?
 
emma_m said:
Congratulations on matching! Personally, I would not get into so much debt but I also don’t know your family situation. I would not want to spend my life paying loans and interest when you also need to buy a house, go on a nice vacation once in a while, buy some other nice things for yourself and your spouse, provide for your kids (when you’ll have them). Real life dentistry is tough and periodontists earn good money if they have exceptional skills and have a good network of dentists they work with. It takes time to build exceptional skills. If during specialty training you do 5 external sinus lifts and place 60 implants, that’s really not worth it for so much money. I’m not sure even ortho is worth going into so much debt. Probably OMFS is, but that requires a lot of commitment and sacrifices vs perio or any other specialty.
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i don’t even know if the training is worth it anymore. I saw a lot of GPs can do all that sinus lifts, crown lengthening, implants, tissue grafts,… All that they can gain the experience from excellent CEs for 1/5 of both cost and time compared to my perio training.
 
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SnowDent98 said:
thank you for the reality check.
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You are welcome. To my wife, it’s the right decision. It’s much better than practicing general dentistry. It only takes an hour to place 2-3 implants and the production is easily 2-3x more than what a GP produces in 8 hours. With 20 years of practicing perio, she has made many times (at least 5x) more than that $900k amount. She wouldn’t have any problem paying back that $900k loan amount by herself......even if she didn’t marry me. But she only owed $308k….thanks to her moonlight jobs that she had during the 3 years of her perio residency.

It really depends on a person’s personality. I would be terrible periodontist because am totally opposite of my wife. She has a lot of friends. In fact many of my referring GPs are my wife’s friends. I would have a very hard time paying back that $900k if I were a perio.
 
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Undecided__ said:
Can you work during residency?
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My wife moonlighted during her 3 years perio residency. That’s how she learned to extract wisdom teeth fast. That’s how she became very good at restoring implants. That’s how she met a lot of GPs who later become her referring dentists. One of her co-associate GPs later bought a practice and became her boss.

She got paid between $300-350/day, which were the average pay rate for GPs 20 years ago. Without those associate jobs, she would have owed more than $400k, instead of just $308k…..not bad for 7 years of private school education (4 yrs DDS + 3 yrs perio).
 
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SnowDent98 said:
some perio programs pay stipends but I really don’t have what it takes to get in there
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Out of curiosity, what does it take to get in there? I know people with previous clinical experience who do 3rd molar extractions, impacted teeth surgeries, bone grafts including sinus lift, some basic implantology as GPs and who have extensive research experience with publications, awards… and still couldn’t match into any of the perio programs that offer stipends.
 
emma_m said:
Out of curiosity, what does it take to get in there? I know people with previous clinical experience who do 3rd molar extractions, impacted teeth surgeries, bone grafts including sinus lift, some basic implantology as GPs and who have extensive research experience with publications, awards… and still couldn’t match into any of the perio programs that offer stipends.
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class rank, school name, and gpa I believe… I have none of that.
 
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Can you moonlight during residency? Could help offset your loans
 
ThirdMolarz said:
Can you moonlight during residency? Could help offset your loans
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Everyone always offers this solution. It’s a 100% an option, if the program allows it. But damn, as someone who has gone through a rigorous residency, no way I could have moonlighted. Monday- Friday until 6PM. Then Saturday and Sunday you spend tying up loose ends or working on research. If not working on those things, you try and take a breath and spend with family. To me, moonlighting was just not even a though. I was fortunate to not have debt though.
 
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It's much less stressful and you have more free time in dental residency than in dental school. No time consuming lab work (except for prosth residency) after school. No nonstop classes from 8-5 like in dental school.....mostly clinical. No need to earn good grades since this is your last stage of your education. No need to worry about finding patients to meet the graduation requirements.....just serve your 2-3 years.....and you earn your specialty certificate.

We had plenty of time to hang out after school. The problem was we were poor and couldn't afford to eat out too often. I wish I could moonlight. I didn't have the license since I did my residency outside of my home state.
 
charlestweed said:
It's much less stressful and you have more free time in dental residency than in dental school. No time consuming lab work (except for prosth residency) after school. No nonstop classes from 8-5 like in dental school.....mostly clinical. No need to earn good grades since this is your last stage of your education. No need to worry about finding patients to meet the graduation requirements.....just serve your 2-3 years.....and you earn your specialty certificate.

We had plenty of time to hang out after school. The problem was we were poor and couldn't afford to eat out too often. I wish I could moonlight. I didn't have the license since I did my residency outside of my home state.
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So, you can't moonlight if your residency is in a state where you didn't graduate??(assuming, the residency allows moonlightinG)
 
Undecided__ said:
So, you can't moonlight if your residency is in a state where you didn't graduate??(assuming, the residency allows moonlightinG)
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No. I couldn't because I didn't have the license to practice in the state where I did my ortho residency. I only had the CA license and could only practice in CA. Back in my time, CA had its own state board exam.

I did moonlight when I was a GPR resident (and my director didnt know about it:)) because it's in Los Angeles.
 
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For OMFS programs if people moonlight it's pretty much exclusively during medical school years. Some programs and set ups you can definitely clear over 100k a year moonlighting as an exodontist and put some dent into loans actually or at least prevent them form ballooning. That's probably the exception; however, moonlighting can definitely give a little extra spending money when living off of loans that barely cover living expenses but more importantly they would offer some hand skills instead of going 2-3 years without touching a tooth.
 
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BYU4you said:
For OMFS programs if people moonlight it's pretty much exclusively during medical school years. Some programs and set ups you can definitely clear over 100k a year moonlighting as an exodontist and put some dent into loans actually or at least prevent them form ballooning. That's probably the exception; however, moonlighting can definitely give a little extra spending money when living off of loans that barely cover living expenses but more importantly they would offer some hand skills instead of going 2-3 years without touching a tooth.
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For every $50k that you don’t have to borrow now, you will save yourself at least $6-700 a month in student loan repayment for the next 10 years of your life.
 
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No! I can’t even afford a McDonalds Happy Meal!
 
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Big Time Hoosier said:
And they will likely not even be paying enough under these plans to cover their accruing interest. So, their loans will actually grow over time. Might want to Google a certain Mike Meru to see how this plays out.

Big Hoss
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Let’s assume OP moves forward with perio and ends up owing $1,000,000. Let’s assume they are making $300,000 after graduation. So under IBR, they only have to pay 10 to 15% of their discretionary income. So even at 15% of their total income, they’d be paying $45,000. Not too bad when you’re making $300,000. But, you accrued $70,000 in interest that first year. So, your loan balance actually grew $25,000! Compound that over the next 20 years and they’ll owe A LOT! When the balance is forgiven in 20 years that’s a gnarly tax bomb! Mike Meru the orthodontist whose loans snowballed started with around $600,000 in debt and figures his loan balance will be over $2,000,000 when it’s forgiven. OP could be pushing $3,000,000 to $4,000,000. Do you want to pay a tax bill on $4,000,000 of income, when in reality you make a fraction of that? I’m sure the IRS will be understanding...

Big Hoss
 
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One could try to find a PSLF gig, but for some reason the types of people who take on crippling loans also detest delayed gratification.
 
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Big Time Hoosier said:
Let’s assume OP moves forward with perio and ends up owing $1,000,000. Let’s assume they are making $300,000 after graduation. So under IBR, they only have to pay 10 to 15% of their discretionary income. So even at 15% of their total income, they’d be paying $45,000. Not too bad when you’re making $300,000. But, you accrued $70,000 in interest that first year. So, your loan balance actually grew $25,000! Compound that over the next 20 years and they’ll owe A LOT! When the balance is forgiven in 20 years that’s a gnarly tax bomb! Mike Meru the orthodontist whose loans snowballed started with around $600,000 in debt and figures his loan balance will be over $2,000,000 when it’s forgiven. OP could be pushing $3,000,000 to $4,000,000. Do you want to pay a tax bill on $4,000,000 of income, when in reality you make a fraction of that? I’m sure the IRS will be understanding...

Big Hoss
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just move your student loans from Sallie Mae to the IRS!

poof, problem solved.
 
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Big Time Hoosier said:
Let’s assume OP moves forward with perio and ends up owing $1,000,000. Let’s assume they are making $300,000 after graduation. So under IBR, they only have to pay 10 to 15% of their discretionary income. So even at 15% of their total income, they’d be paying $45,000. Not too bad when you’re making $300,000. But, you accrued $70,000 in interest that first year. So, your loan balance actually grew $25,000! Compound that over the next 20 years and they’ll owe A LOT! When the balance is forgiven in 20 years that’s a gnarly tax bomb! Mike Meru the orthodontist whose loans snowballed started with around $600,000 in debt and figures his loan balance will be over $2,000,000 when it’s forgiven. OP could be pushing $3,000,000 to $4,000,000. Do you want to pay a tax bill on $4,000,000 of income, when in reality you make a fraction of that? I’m sure the IRS will be understanding...

Big Hoss
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While I agree that having upwards of $1,000,000 in loans is absolutely absurd, the math here isn't quite correct. For IBR, and more specifically REPAYE, it's 10% of your discretionary income which, for a single person making $300k, would be $2,349 a month or $28k a year, and $2,193 a moth or $26k a year for a family of 4 if they're married with 2 kids. Obviously as income goes up, that monthly payment goes up as well, which could be upwards of 60k a year. Under REPAYE, whatever amount of interest your monthly payment doesn't cover, half of that is subsidized. So if the interest rate is around 6.5%, then that's $65k a year, minus the $28k in payments made would be $37k in accrued interest, divided in half since that's subsidized, and it's an increase of $18.5k a year. After all is said and done, after 25 years of doing this, the loans will be above $2,250,000 and the OP probably will have paid around $1,000,000, and then will have the $1,250,000 forgiven, and then pay taxes on that, which could be anywhere around $550k in taxes! The total amount wouldn't get over 3 million and nowhere near 4, but it would still be an ugly amount.
I think a periodontist will definitely make over 300k a year as they get farther into their career, so those numbers would definitely change, and they would probably just refinance, so all this math would be moot. Either way you look at it, it's an insane amount of debt to go into for perio residency, and it would be hard to justify. But if OP is dead set on perio, then they just need to come to terms with needing to live a humble life for a while while paying down debt.
 
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