Is specializing really worth it? ( Financially )

[Velma Dinkley]

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Assuming we have somebody who wants stability, therefore he/she would want to buy an established practice rather than set up a new practice, would specialization really be worth it?


I'm thinking that it would be difficult to find a specialty practice for sale, considering they are not as common as general practices. Additionally, the money you save on not going into a training program and working instead could be used to buy a high-producing general practice. This amount should be around $350-$500K.

I can't help but feel as though I'm missing something, it can't be this simple, anyone want to give me advice?

 

[CMistry]

For simplicity's sake let's say specializing costs you a total of $500k (including lost income, loan interest, living costs, etc.).

From the ADA website (http://www.ada.org/1444.aspx):
"The average net income for an independent private practitioner who owned all or part of his or her practice in 2009 was $192,680 for a general practitioner and $305,820 for a specialist. "

Now many dentists will claim those #s are bogus, but they come from the most official set of data we have to work with.

Anyways it's easy to see that over one's lifetime it is definitely financially advantageous to be a specialist. I'm not even bringing up the fact that specialists don't work nearly the same hours as a GP.

 

[KSDental]

Specializing has potentially greater reward, but higher risk. I think its better to specialize because you want to, not because you think its financially advantageous. I personally would not feel comfortable going 500k into debt to become a specialist with no guarantee of a really high salary afterwards. Dentistry isn't like medicine where specialists are almost certain to get higher pay. In dentistry your salary is much more dependent on how well your business is run.

 

[yappy]

Is it true that many successful oral surgeons and orthodontists make high 6 figures/low 7 figures?

 

[Silent Cool]

Specializing has potentially greater reward, but higher risk. I think its better to specialize because you want to, not because you think its financially advantageous. I personally would not feel comfortable going 500k into debt to become a specialist with no guarantee of a really high salary afterwards. Dentistry isn't like medicine where specialists are almost certain to get higher pay. In dentistry your salary is much more dependent on how well your business is run.

More like 750K in debt...

 

[Silent Cool]

For simplicity's sake let's say specializing costs you a total of $500k (including lost income, loan interest, living costs, etc.).

From the ADA website (http://www.ada.org/1444.aspx):
"The average net income for an independent private practitioner who owned all or part of his or her practice in 2009 was $192,680 for a general practitioner and $305,820 for a specialist. "

Now many dentists will claim those #s are bogus, but they come from the most official set of data we have to work with.

Anyways it's easy to see that over one's lifetime it is definitely financially advantageous to be a specialist. I'm not even bringing up the fact that specialists don't work nearly the same hours as a GP.

bogus as in too high or too low? or just poorly collected?

 

[CMistry]

bogus as in too high or too low? or just poorly collected?

Most of what I hear is too low.

 

[hellopeople]

I personally like ortho as a specialty if you were just doing this for the money. It's a shorter residency, they make a lot, the risk for back injury is greatly reduced, and you're relatively insulated from mid-levels as well as anything that would cause a reduction in demand for restorative.

Oral surgeons do obscenely well of course, but the residency is no joke. I'm sort of sad that the teeth and titanium part of OS pays so well because I'm in the middle of my class as far as rank goes and after seeing an oral surgeon perform le fort surgery I think the work is amazing. Way to competitive for someone as laid back as me to have a shot thanks to the kind of bank they make.

Perio seems risky to do just for the money. Sinking implants might not always be in the cards for them to the same degree as is the case now. I like endo too, but everyone likes to point out that rotary instruments and implants are going to crush the specialty.

 

[Contach]

I'm sort of sad that the teeth and titanium part of OS pays so well because I'm in the middle of my class as far as rank goes and after seeing an oral surgeon perform le fort surgery I think the work is amazing. Way too competitive for someone as laid back as me to have a shot thanks to the kind of bank they make.

Is 'laid back' a euphemism for lazy?
If you try harder, maybe you too can do something amazing.

 

[Bereno]

Yes, it is financially worth it. Also, I agree with Contach - I am a very laid back person as well, but I am still putting in very high levels of effort (competing) for OMFS. I don't see why these are mutually exclusive... Hell, being laid back might even be an advantage for a surgeon since they can keep their cool in stressful situations, though I'm just saying that to make myself feel better haha.

 

[johnho771]

Is it still financially worth it if a person goes to a residency that charges tuition and the person funds it with loans? Seems like this could be a substantial amount of debt atop what might already be significant debt from dental school. Also what do people generally do for employment after completion of residency. Are there a lot of associateship for things like perio and ortho. I also imagine it is more difficult to establish yourself as a specialist, relying more on referrals. I have also seen how some specialists like ortho who need to own multiple offices just to have enough patients. I imagine this would take some time to establish.

 

[nomad12]

What do you guys think about endo?

 

[charlestweed]

Is it still financially worth it if a person goes to a residency that charges tuition and the person funds it with loans? Seems like this could be a substantial amount of debt atop what might already be significant debt from dental school. Also what do people generally do for employment after completion of residency. Are there a lot of associateship for things like perio and ortho. I also imagine it is more difficult to establish yourself as a specialist, relying more on referrals. I have also seen how some specialists like ortho who need to own multiple offices just to have enough patients. I imagine this would take some time to establish.

That’s why you should go to a public school for your undergrad study and avoid going to an expensive “reputable” dental school (such as UPenn, Harvard). When you later decide to specialize, you won’t end up with a huge amount of debt even if you get accepted to a specialty program that charges tuition. I feel sorry for many 17-18 yo kids, who decide to go to OOS undergrad schools, because they think they will become more mature by living away from their parents. To me, a more mature financial decision would be to save money by living with the parents and going to a local state taxpayer- funded school. IMO, a person becomes more mature when he/she grows up under hardship conditions such as sharing room with roommates, working part time while in school etc. Do you want to work hard in your 40s and 50s to pay off the loans because of your poor financial decisions? Or Do you want to work less and drive a BMW in your 30s because of the sacrifices you made earlier in your life?

Are there a lot of associateship opportunities for perio or ortho? The answers are both yes and no. Yes if you are willing to work hard for less at the beginning. No if you are a stubborn person who refuses to work for than less $1000 a day. When I first started ortho at my sister’s GP office, I got paid close to nothing during the first few months. My income increased as I gained more and more patients. Now, I make the most per day at that office.

Your success as a specialist pretty much depends on how well you run your business, how good you are at communicating with the GP, your clinical skills, your chair side manner etc. If you hate dealing with (and kissing up to) the referring GPs, then you shouldn’t specialize. Having an OMFS or an ortho certificate does not automatically make you a rich doctor. You will have to work hard to earn the GPs’ and the patients’ trust. It takes time and a lot of hard work to build the reputation. It just doesn’t happen overnight.

The reason many orthos open more than one office is they can see a lot of patients (50-80 patients) in a day. Therefore, they don’t need to work 5 days/week at one location to take care of all of their patients. They open up more satellite offices to make more.

 

[NTATD]

Bereno
What is the "competing" like at a pass fail school? Does everyone know how you compare with classmates? Or is most of your focus on learning for boards? I go to a school with ranks, so I'm just trying to picture how the other half of omfs hopefuls live. Thanks

 

[Bereno]

Is it still financially worth it if a person goes to a residency that charges tuition and the person funds it with loans? Seems like this could be a substantial amount of debt atop what might already be significant debt from dental school. Also what do people generally do for employment after completion of residency. Are there a lot of associateship for things like perio and ortho. I also imagine it is more difficult to establish yourself as a specialist, relying more on referrals. I have also seen how some specialists like ortho who need to own multiple offices just to have enough patients. I imagine this would take some time to establish.

Just like all things, there is a distribution of possibilities here. In general, I think specializing is definitely worth it. However, there will always be circumstances that may make it more or less valuable to someone. If someone was older, then it may not be as valuable because they would be forgoing a larger percentage of their work years to residency years instead. The point is that you can always find a way to justify it one way or the other. In general though, I still see the value in it.

Bereno
What is the "competing" like at a pass fail school? Does everyone know how you compare with classmates? Or is most of your focus on learning for boards? I go to a school with ranks, so I'm just trying to picture how the other half of omfs hopefuls live. Thanks

Competing at UConn is quite difficult. However, I am not really competing against my peers here at school as much as I am competing against other OMFS applicants... The exams here are long (4.5 hour exams) with low averages. Its a very grueling school, so you have to work hard just to pass, let alone excel. Nobody here as a rank, so none of us know where we stand relative to anyone else. Most of us who are looking at specialties are focused more on boards than anything. That said, having no class rank is both a stress reliever, and a stress inducer. Since we don't know how we are doing relative to our classmates, we dont really have a gauge of our performance - it makes things a bit uncertain. Plus, there are some brilliant people on my class. Quite a few UConn students are posting 80+ CBSE scores with some clearly up in the 90s. Seems like the average here is around a 74-75 or so (just from the scores I know about). Competing against these guys and gals is tough, especially considering how we don't know our rank haha. These added uncertainty aside though, I would much rather not have the rank - one less thing to focus on and stress over. I hope that answered your question. 🙂

 

[Velma Dinkley]

You bring good arguments, citing higher average salaries and usually fewer working hours; however, I can't help but feel it is higher risk. It seems to be quite time consuming to establish yourself in an area, and you very well could be making less than a high producing general dentist that used all the saved money to buy a nice practice out of school for a time that could range from a few years to a decade or two. All this is compounded by lost wages and tuition for specialist training.

What do you think?

 

[Silent Cool]

You bring good arguments, citing higher average salaries and usually fewer working hours; however, I can't help but feel it is higher risk. It seems to be quite time consuming to establish yourself in an area, and you very well could be making less than a high producing general dentist that used all the saved money to buy a nice practice out of school for a time that could range from a few years to a decade or two. All this is compounded by lost wages and tuition for specialist training.

What do you think?

Velma,

The trend now is for generalists to perform more procedures that were traditionally the domain of specialists. Good CE can take you far.
That said, I think that specialists will always be needed, and it may be less stressful to focus on one thing/procedure than to be a "jack of all trades."

Re: opportunity cost of specializing, I think that is debatable. Many new grads will enter a GPR for a year, and then come out making 100k or so the next year. You could instead spend two years in Ortho or Pedo and make quite a bit more. In that case, I don't think there really is much opportunity cost of specializing. The math changes, however, if you will have to borrow a lot of money for specializing, such as if you attended USC Ortho (may God have mercy on your soul!).

I think the long-term higher income of specialties tips the cards in favor of specializing if you can/want to. Just avoid the high tuition programs.

 

[nomad12]

I am surprised people still want ortho. I heard lots of orthodontists take FOREVER to retire and that many of them aren't going to be retiring soon because of the recession. I also know that there are around 63-65 ortho residency programs, and I'm sure more will open up. Most of these new residencies charge astronomical tuition.

By the way, what do people think of endo as a specialty? Seems a lot of endo programs are also getting on the bandwagon of charging tuition.

 

[Silent Cool]

I am surprised people still want ortho. I heard lots of orthodontists take FOREVER to retire and that many of them aren't going to be retiring soon because of the recession. I also know that there are around 63-65 ortho residency programs, and I'm sure more will open up. Most of these new residencies charge astronomical tuition.

By the way, what do people think of endo as a specialty? Seems a lot of endo programs are also getting on the bandwagon of charging tuition.

Yeah, I think every specialty is starting to charge tuition now. I think the number of Ortho spots increased from about 240 10 years ago to 340 now. Funny how changes in supply and demand can change the appeal of these fields. I think Pedo is probably the new Ortho, but many of those programs too are starting to charge tuition.

 

[sjv]

Yeah, I think every specialty is starting to charge tuition now. I think the number of Ortho spots increased from about 240 10 years ago to 340 now. Funny how changes in supply and demand can change the appeal of these fields. I think Pedo is probably the new Ortho, but many of those programs too are starting to charge tuition.

For the most part, it seems that hospital/medical center affiliated residencies pay similar to a medical resident or receive some sort of compensation whereas dental school based residencies end up charging tuition.

 

[coolslugs]

What about Pros?

 

[Silent Cool]

What about Pros?

I think most Pros programs charge tuition.

Here is a thread from Dentaltown about going into 500K of debt for Pros:

'Prosthodontics or not? 500K of debt?'

http://www.dentaltown.com/MessageBoard/thread.aspx?a=11&s=2&f=214&t=182546&g=1&st=500k debt