OMS private practice AMA

[IHO]

So, bring on the ?s no BS no spin zone. I graduated DS 1999 and OMS residency 2006. Worked as an associate for 1 year for a retiring OMS and bought his practice. Ask me about money/debt/business/personal relationships/personal finance/hobbies/philosophy whatever.

Igy

---

Members don't see this ad.

 

[Steins;Gate]

Why did you decide to pursue dentistry and, later, OMFS? Any regrets about your career? Anything you would change about your career? Did you think you chose the right specialty?

 

[Iroh]

Where did you attend for DS and Residency?

 

[IHO]

Why did you decide to pursue dentistry and, later, OMFS? Any regrets about your career? Anything you would change about your career? Did you think you chose the right specialty?

In my senior year of highschool I fell in love with biology...I took an AP class with lots of cell/molecular bio. Fascinating! In college, I learned bio people teach or go into health care professions. I did not want to teach. So...
my sophomore year I found a job working for an orthodontist. Fell in love...creating biomechanical systems to manipulate growth...fascinating! that led to dental school. so....
In dental school (2nd year) I was introduced to OMS, and really fell in love with the instant gratification of surgery....results in hours, not years. so...
No real regrets. OMS has provided me with a beautiful combination of lifestyle and income and control that I could not imagine with other careers.

Igy

 

[IHO]

Where did you attend for DS and Residency?

I prefer to maintain some anonymity...let's say a private dental school and a big deep south residency 🙂
Igy

 

[iLikeTrains]

Thanks in advance -- it's always nice to hear from those like you. 🙂

1. When did you finish paying your debts? And if you are willing to share, what are the salaries for OMS like?
2. Since you did the 6(?) year OMS residency, do you think the MD was worth it? Why/why not?
3. Given increasing tuition and housing costs, do you think OMS is still a good investment for incoming dental students?
4. How difficult was it to open a OMS private practice, and how difficult do you think it will with debt, competition, and the shrinking middle class?
5. How did you handle relationships/family during that time?
6. What hobbies do you have and how much time do you have for them?

 

[Steins;Gate]

You mentioned also being interested in orthodontics. What made you decide OMFS over ortho? Also, how hard was it for you to match into an OMFS program? Did you have to apply several times? Did you complete an internship? I.e. can you tell us the process of going from wanting to match into OMFS to matching into OMFS?

 

[IHO]

Thanks in advance -- it's always nice to hear from those like you. 🙂

1. When did you finish paying your debts? And if you are willing to share, what are the salaries for OMS like?

I finished residency with combined undergrad/dental school/medical school loans around 300K. I bought a house for about 225K. I bought a practice (instruments/goodwill) for 750K. I bought an office building for 350K. As of last month, I owe about 250K on the office building. All other debt has been retired for about 2 years.

2. Since you did the 6(?) year OMS residency, do you think the MD was worth it? Why/why not?
Great ?. For me, personally, yes. As I mentioned earlier, biology was my first love, and from that health science professions. Early in college, I considered pursuing an MD degree and actually obtaining an MD was emotionally satisfying and helped solidify in my mind that I made the right decision to go to dental school. Has it "helped" me from a business standpoint....probably minimally, if at all. Occasionally I will have a pt tell me they felt more comfortable coming to me because of the extra initials.
3. Given increasing tuition and housing costs, do you think OMS is still a good investment for incoming dental students?
Another good ?. The following answer is my personal opinion only. I think OMS is the most lucrative option in dentistry. Given increasing costs in obtaining dental education, OMS absolutely makes sense, because it gives great potential to pay off loans and have a good lifestyle. However DO NOT go to dental school to be an OMS. You have to consider the possibility you will never get into an OMS program and will be a general dentist.
4. How difficult was it to open a OMS private practice, and how difficult do you think it will with debt, competition, and the shrinking middle class?
Not difficult at all. I bought an existing practice from a retiring doc. I put zero effort into marketing the practice...I basically show up and treat the patients in the waiting room. After 10+ years, the practice demographics have probably changed a bit, but overall production has remained steady. I am in a smallish town and I think that has helped a bit. Not a lot of competition. Low cost of living.
5. How did you handle relationships/family during that time?
I was married throughout dental school. Had one baby in dental school and 3 more in residency. Having an AMAZING spouse is key. She knew (before we got married) that there were going to be 6+ ****ty years. There were weeks in residency that I never saw my family....they were asleep when I left for the hospital and asleep when I got home. We hung in there for the payoff that we knew was coming. It was (is) worth it. But without frank communication and realistic expectations, I', not so sure we would have made it. It was not easy.
6. What hobbies do you have and how much time do you have for them?

I like traveling with my family, I like cooking, I like eating and drinking wine with my cooking. I like reading history. I like playing chess. I work 30- 40 hours a week and take 15 weeks of vacation a year, so I have plenty of time for family and vacation.

thanks for the ?s!!
Igy

 

[2TH MVR]

Igy,

Thanks for doing this. A lot of students really curious about OMS.
I have a question for you. You mention that you practice in a smallish town with little competition. Do you think it would have been more difficult for you to thrive economically in a large city (say, like Phoenix, LA, Chicago, NY, etc.) as compared to the smallish town?

 

[IHO]

Igy,

Thanks for doing this. A lot of students really curious about OMS.
I have a question for you. You mention that you practice in a smallish town with little competition. Do you think it would have been more difficult for you to thrive economically in a large city (say, like Phoenix, LA, Chicago, NY, etc.) as compared to the smallish town?

Probably. Income might be similar, but cost of living would make a world of difference. You can live like a pimp on 250K in small down,usa; in manhattan, 250K is not so much.

Igy

 

[Pearl E. White]

Hi Igy,
I would like to know where to get started regarding practice ownership. I am not in dental school yet, but I think it is never too early to start thinking about my future and what I want to do with it. At this stage in my career (applying next cycle for the first time) where is the best place to start?

Thanks!

 

[predental21250]

What was your class rank when you finished? did you get into the program you wanted? 4 year or 6 year?

 

[Medin2017]

So, bring on the ?s no BS no spin zone. I graduated DS 1999 and OMS residency 2006. Worked as an associate for 1 year for a retiring OMS and bought his practice. Ask me about money/debt/business/personal relationships/personal finance/hobbies/philosophy whatever.

Igy

1. What was your lifestyle like in residency? Can you describe a typical day I guess for each year?

2. Do you practice in a hospital at all on any days?

3. What is a typical starting and avg for OMFS you know (and job offerings around)? Can you give a ballpark estimate of yourself going from associate to where you are now?

4.Favorite procedure(s)?

5. What do you think OMFS will look like in the future?

6. Any advice you would give to a dental student in the trenches? Sometimes stress can be high and it's easy to think "why not go into general dentistry/specialty that isn't as vigorous" when you're just a dental student who knows so little.

Thanks a lot for this AMA.

 

[testtest123]

Probably. Income might be similar, but cost of living would make a world of difference. You can live like a pimp on 250K in small down,usa; in manhattan, 250K is not so much.

Igy

Its more likely that the income may change in a bigger city and the cost of living increases as well. Whether or not if that income increase is worth it can vary.

 

[DentalNucleicAcid]

Did you find your debt burden from dental school and residency to be a bother to you when you graduated OMS or did the extra income of OMS help you pay it off more easily? Tuition was probably much lower when you were in school but what would you think of today's OMS graduate?

 

[IHO]

What was your class rank when you finished? did you get into the program you wanted? 4 year or 6 year?

top10. applied to 15, interviewed at 9 ranked 6. I got my top pick. 6 year program.

Iggy

 

[IHO]

Did you find your debt burden from dental school and residency to be a bother to you when you graduated OMS or did the extra income of OMS help you pay it off more easily? Tuition was probably much lower when you were in school but what would you think of today's OMS graduate?

Not really a huge burden. Practice debt (about 1 mil for goodwill/equipment/building) was a bigger nut than school loans (about 300K combined undergrad,dental,medical). My year as an associate, I made minimal payments on debt. After I bout the practice my income almost trippled, and I began aggressive repayment of loans. There was still plenty of money for an extremely comfortable lifestyle.
Iggy

 

[IHO]

1. What was your lifestyle like in residency? Can you describe a typical day I guess for each year?

2. Do you practice in a hospital at all on any days?

3. What is a typical starting and avg for OMFS you know (and job offerings around)? Can you give a ballpark estimate of yourself going from associate to where you are now?

4.Favorite procedure(s)?

5. What do you think OMFS will look like in the future?

6. Any advice you would give to a dental student in the trenches? Sometimes stress can be high and it's easy to think "why not go into general dentistry/specialty that isn't as vigorous" when you're just a dental student who knows so little.

Thanks a lot for this AMA.

1.lifestyle in residence: brutal.It sucked. Med school was really cushy (in many ways much easier than dental school). 5th year was not to bad. Intern year was brutal. General surgery pretty tough (although probably easier now with the 80 hour cap, I missed that by a few years). 6th year had somewhat better hours but much more demanding in terms of overall responsibility/stress.

2. I take call...its fairly quiet, seems like I get more pus cases than anything else. My private practice is mostly bread and butter stuff so 99.9% of it I do in the office.

3. offers I got for associate positions 200-225K with basic perks (401K match, 2 weeks CE, incentive bonuses, health insurance ect). That was a little while ago, though. ball park compensation counting w2 salary, pension plan, CE, wife and kid's salaries, "pass through" income, and other misc. perks run through the office, mid 6 figures.

4.pulling teeth

5. working harder for less money. I think that is the wave of the future for all dental and medical specialties. There will always be boutique cash only practices doing high end procedures on high end patients making a bloody fortune. There will always be the medicaid chop shops that take every insurance offered and make sausage all day long. Then there is everybody else who has a variable mix of insurances and cash pay patients...this is the group that will be squeezed the hardest; there won't be as much room with the unicorns at the top, so it will be downward pressure. This is a very short answer to a complex question.

6. study hard and keep your grades up. Borrow as little money as possible. good luck!

 

[IHO]

Hi Igy,
I would like to know where to get started regarding practice ownership. I am not in dental school yet, but I think it is never too early to start thinking about my future and what I want to do with it. At this stage in my career (applying next cycle for the first time) where is the best place to start?

Thanks!

Good luck with the application process! Start with forums like this and dental town. DT is probably better...lots of groups talking about buying practices, practice management, retirement planning ect.

Iggy

 

[averageasian]

Did you graduate from a dental school with a medical school curriculum or a traditional one?

If you could re-do dental school (not that you’d want to) what would you have done differently knowing you wanted OMFS?

Thank you so much for this.

 

[IHO]

Did you graduate from a dental school with a medical school curriculum or a traditional one?

If you could re-do dental school (not that you’d want to) what would you have done differently knowing you wanted OMFS?

Thank you so much for this.

more traditional curriculum. Going back to DS I would have done nothing differently.
Ig

 

[Medin2017]

1.lifestyle in residence: brutal.It sucked. Med school was really cushy (in many ways much easier than dental school). 5th year was not to bad. Intern year was brutal. General surgery pretty tough (although probably easier now with the 80 hour cap, I missed that by a few years). 6th year had somewhat better hours but much more demanding in terms of overall responsibility/stress.

2. I take call...its fairly quiet, seems like I get more pus cases than anything else. My private practice is mostly bread and butter stuff so 99.9% of it I do in the office.

3. offers I got for associate positions 200-225K with basic perks (401K match, 2 weeks CE, incentive bonuses, health insurance ect). That was a little while ago, though. ball park compensation counting w2 salary, pension plan, CE, wife and kid's salaries, "pass through" income, and other misc. perks run through the office, mid 6 figures.

4.pulling teeth

5. working harder for less money. I think that is the wave of the future for all dental and medical specialties. There will always be boutique cash only practices doing high end procedures on high end patients making a bloody fortune. There will always be the medicaid chop shops that take every insurance offered and make sausage all day long. Then there is everybody else who has a variable mix of insurances and cash pay patients...this is the group that will be squeezed the hardest; there won't be as much room with the unicorns at the top, so it will be downward pressure. This is a very short answer to a complex question.

6. study hard and keep your grades up. Borrow as little money as possible. good luck!

By mid 6 figures did you mean like 500? I didn't know all that stuff (pension plan, CE, etc ) added up to so much. Thanks for the advice. And yea I can definitely see reimbursement dropping in every field (except maybe computer science but then again other nations are working hard on that so competition is at an all time high). Not as bright a future as I'd like, but at least in the meantime omfs income went up according to the ADA anyway.

Finally why 6 year over 4 year?

 

[IHO]

By mid 6 figures did you mean like 500? I didn't know all that stuff (pension plan, CE, etc ) added up to so much. Thanks for the advice. And yea I can definitely see reimbursement dropping in every field (except maybe computer science but then again other nations are working hard on that so competition is at an all time high). Not as bright a future as I'd like, but at least in the meantime omfs income went up according to the ADA anyway.

Finally why 6 year over 4 year?

I addressed why 6 year in a previous post.
Someone asked what my "ball park" income was, to which I replied mid 6 figures. I would say #s from 400-600K would be in this ball park, and 500K would be right in center field.
Ig

 

[BosDent93]

Say you couldn't get into an OMS residency, what would your next 1 or 2 choices be for fields in dentistry and why?

 

[wtayjay]

I was curious how you managed to take so much time off. I am very interested in OMFS and it's my dream to be able to take that much time off, as my wife and I love to travel. Do your referring dentists not get tired of you always being off?

 

[IHO]

I was curious how you managed to take so much time off. I am very interested in OMFS and it's my dream to be able to take that much time off, as my wife and I love to travel. Do your referring dentists not get tired of you always being off?[/QUOTE
Hasn't seemed to bother anyone yet🙂. Travel is a gamble as I am always on call for my patients...fortunately (and I am seriously pounding on wood as I type) 99.999999999% of PP calls are non-emergent that can be handled over the phone. I am always resigned to the fact that .000000001% of the time away, I may have to return home to deal with a real emergency. I am always very judicious about procedures I schedule before heading out of town, especially if for a longer trip. A lot of my vacation time is in the form of long weekends or random days off to chill at the house. Mini breaks, for me, are incredibly helpful to recharge and refresh.

 

[IHO]

Say you couldn't get into an OMS residency, what would your next 1 or 2 choices be for fields in dentistry and why?

Ortho would be my 2nd choice. Other than that...I don't know. Maybe oral radiology or path...no whiny patients to deal with.

 

[BosDent93]

Ortho would be my 2nd choice. Other than that...I don't know. Maybe oral radiology or path...no whiny patients to deal with.

Is that because of similar lifestyle and compensation, or because of the type of work being done?

 

[drbike123]

Igy, thanks for this thread! What a great resource it is to us younger guys. I’m a PGY-2 at a 4 year program and am thinking about going the same route you did as far as buying a practice fairly soon after completion of residency. A couple of questions if you don’t mind:
1. How did you go about finding opportunities for associateships/buy ins/purchase options? Did you use a company to help you like OMS Exclusively? Scan the AAOMS classifieds? Personally contact surgeons in the geographical area you and your family were interested in? Word of mouth? I know there are a lot of ways to do it and just wondering how your experience was for you.
2. Was it fairly easy to get a business loan for your practice? What bank did you use and were they easy to work with?
3. Did you use a company to help you review your associate contract, purchase contract, practice evaluation, etc.? Or did you just use any attorney to look over your forms.
4. Would you recommend waiting a year or two before buying into a practice like you did vs buying right after completion of residency? I would imagine learning the business side of things while new into private practice all while preparing for boards might be a little overwhelming.

That’s all I can think of for now. Thanks for your time and willingness to create this thread.

 

[deleted782438]

Do you ever wonder what your life would have been like if you joined a surgical department at a hospital? After working in private practice is the option of joining a hospital group still available?

Did you let schools know private practice OMS was your goal while applying to OMS programs?

Do you think your chances of getting into OMS residency would have been negatively impacted if you were to do research in dental school? (would research experience compensate the lower gpa or do OMS residencies only focus on grades?

 

[lamemrsa]

1.Do you think getting a 4 year OMFS Certificate would've made any difference in terms of practice? Do you think that GP’s refer the bread and butter cases to the 4 year guys and give you the complicated procedure?

2. Do you feel like there is a lot of competition from GP's doing extractions/implants? From other OS's? - do you practice in the South, MW, NE, West Coast?

3. Is the Mid-100's you described after paying practice loans and DS loans... pre tax?

Thanks 🙂

 

[IHO]

Igy, thanks for this thread! What a great resource it is to us younger guys. I’m a PGY-2 at a 4 year program and am thinking about going the same route you did as far as buying a practice fairly soon after completion of residency. A couple of questions if you don’t mind:
1. How did you go about finding opportunities for associateships/buy ins/purchase options? Did you use a company to help you like OMS Exclusively? Scan the AAOMS classifieds? Personally contact surgeons in the geographical area you and your family were interested in? Word of mouth? I know there are a lot of ways to do it and just wondering how your experience was for you.

AAOMS classifieds

2. Was it fairly easy to get a business loan for your practice? What bank did you use and were they easy to work with?

Owner financed the deal. When I applied for a consolidation loan 5 years later at a lower interest rate, I used a local credit union and had no problems qualifying for the loan. The bank did check over corporate tax returns and did a credit check, so if there had been issues with business profitability or credit worthiness, it may not have gone down so smooth

3. Did you use a company to help you review your associate contract, purchase contract, practice evaluation, etc.? Or did you just use any attorney to look over your forms.

A personal friend/attorney reviewed the associate contracts. To buy the business, I just kinda did it on my own. No regrets, but I was probably naive/lucky. Probably a good idea to get an attorney to check things out

4. Would you recommend waiting a year or two before buying into a practice like you did vs buying right after completion of residency? I would imagine learning the business side of things while new into private practice all while preparing for boards might be a little overwhelming.

Probably a very personal decision, but I would lean towards not waiting. Take an associateship with minimal delay until owning the business or being a full partner ( 1 year max). Learning business management is not terribly difficult.

Iggy

 

[IHO]

Do you ever wonder what your life would have been like if you joined a surgical department at a hospital?

No

After working in private practice is the option of joining a hospital group still available?

yes and no. Hospitals are dying to have any qualified surgeon willing to clean up ****. Personally, I feel my skills are probably a bit rusty, but operating is kinda like riding a bike. I'm sure the skills would come back.

Did you let schools know private practice OMS was your goal while applying to OMS programs?


when applying, it was, honestly, not my goal. I wanted to do a craniofacial fellowship and be an academic surgeon. By third year of residency the desire to do a fellowship faded. By the fourth year the desire to be an academic surgeon faded. by the fifth year the desire to do anything other than pull teeth faded.

Do you think your chances of getting into OMS residency would have been negatively impacted if you were to do research in dental school? (would research experience compensate the lower gpa or do OMS residencies only focus on grades?

not really sure on this one. probably the best thing to compensate a lower GPA would be crushing the dental boards (back in the day, now, I suppose crushing the CBSE ?)

 

[IHO]

1.Do you think getting a 4 year OMFS Certificate would've made any difference in terms of practice? Do you think that GP’s refer the bread and butter cases to the 4 year guys and give you the complicated procedure?

no and no

2. Do you feel like there is a lot of competition from GP's doing extractions/implants? From other OS's? - do you practice in the South, MW, NE, West Coast?

not a lot of competition. I pract

3. Is the Mid-100's you described after paying practice loans and DS loans... pre tax?

mid 6 figures is my personal gross income. all debt repayment came out of my net income (some of the business loans came out pretax)



Thanks 🙂

 

[786783]

How physically demanding is doing bread and butter OS all day, everyday? (Wrist, especially.)

How long do you want to practice for?

Can you describe a typical day in your office please?

Thanks.

 

[IHO]

How physically demanding is doing bread and butter OS all day, everyday? (Wrist, especially?

I am definitely tired by the end of the day. Wears on the neck much more than the wrist. So far, late 40s, and doing well.

How long do you want to practice for?

I hope to be ready to retire in 10 years. At that point, I may continue to work like I am now, or I may work every other week, or I may quit. It all depends on my physical/emotional health. I see no scenario where I am still working in the mouth hole past 60.I

Can you describe a typical day in your office please?

show up around 830-845. average 6 procedures per day, 5-6 consults, 5-6 f/us. exclussively DA stuff. Done with clinical work around 2-3. At the gym or house by 3-4.

Thanks.[/QUOTE]

 

[Greensalad]

show up around 830-845. average 6 procedures per day, 5-6 consults, 5-6 f/us. exclussively DA stuff. Done with clinical work around 2-3. At the gym or house by 3-4.

Thanks.

Nice lifesytle. Sounds like an OMFS that I shadowed in southeast US. Mind if I ask general area where you work? I know of an OMFS in SoCal who drives 2-3 hours one-way per day to a different job and sleeps in his car overnight.

 

[Hanumankrupa72]

I like traveling with my family, I like cooking, I like eating and drinking wine with my cooking. I like reading history. I like playing chess. I work 30- 40 hours a week and take 15 weeks of vacation a year, so I have plenty of time for family and vacation.

thanks for the ?s!!
Igy

Thank you sir for sharing your experience as a OMFS.
I am imaging my future life in your journey. I am working hard to be an oral surgeon.

Thanks for you kindness to share this. no one does it in details like you did.