Ortho Associate Jobs

Discussion in 'Dental Residents and Practicing Dentists' started by jeffdmdo, 09.29.14.

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  1. jeffdmdo

    jeffdmdo

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    Hi all,

    I'm a 3rd year with a strong interest in ortho. Ortho is something I've always wanted to do as I've been personally attached to it through my own story (i.e. ugly ducking becoming a swan after ortho :) ). However, I'm wondering whether specializing in ortho will put me in a bad place financially as I do care about my lifestyle/ability to have a life outside of work. So here's my deal:

    -I just want to be an associate and want to probably practice in San Francisco (it's always been a dream). I'm open to becoming a partner as well, but not really willing to start up a practice.
    -I'm at HSDM (Harvard School of Dental Med.) - does name matter at all? I've been seeing a lot of "name of school doesn't matter" posts on SDN, so it makes me a little scared that I'm graduating with so much debt when I could've went to a cheap, state school (below)
    -I'll leave HSDM with about $270,000 in fed. loans with a consolidated ~7% interest rate
    -I have an extra $110,000 saved up in a savings account, but haven't decided whether to use it for students loans or for starting up a practice (if I absolutely have to). Stipulation here is that I can't take it out until I graduate :(. Interest doesn't capitalize until I do graduate though so I can pay it off before it starts to compound.
    -I ideally want to go into a very specific ortho program in which I wouldn't have to pay (i.e. UCLA --> HSDM has connections, sorry if that sounds pompous but just want to get the truth out there)

    Let me know what you think in terms of finances.... I've never been too great with it. Thanks!
     
    Last edited: 09.30.14
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  3. thewingman

    thewingman 2+ Year Member

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    Obviously you need some advice (financially). What kind of idiot leaves 110,000 in a savings account while paying 7% interest on loans? I am surprised you even go to Harvard (if you even do).
     
  4. jeffdmdo

    jeffdmdo

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    Sorry, I should've mentioned that the 110,000 can't be taken out until after I graduate.
     
  5. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    If you are coming out with 270K from Harvard, that's a pretty good deal.

    Also, coming from Harvard will practically guarantee you a spot in an ortho program somewhere. Just don't be pompous or foolish like some people and apply to only 5-7 programs. Apply to all of the stipend-paying programs and programs with low tuition, and one of those places will take you.

    good luck.
     
  6. Miley Cyrus.

    Miley Cyrus. Eat. Sleep. Twerk. 2+ Year Member

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    You think Ortho is still worth going into?
     
  7. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    I think it's worth it if your debt is low. So if OP has ~110K in savings to which he has access after graduation, his debt is basically 170K. Let's say he can get into a stipend-paying program like Vanderbilt Ortho. Then yeah, I would say that is worth it. He could max a roth IRA for each of the two years at Vandy, and then probably use the rest of his stipend to pay the interest on his debt.

    If he were coming out of Havard with 500K and could only get into USC Ortho, I would have to guess that would be a terrible idea, considering that his debt would be close to 1 million.

    It really seems more and more like it's OMFS or General. There is so much you can do in GD with good CE.
     
  8. 011110

    011110 2+ Year Member

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    That's the million dollar question I have fought with these past few months.

    Dead on. I am applying for ortho for this cycle, but if I don't get in to a stipend program I'm sticking with GP. I am very content with my income as a GP thus far, while some of my friends are RACKING up the debt in perio, endo, or ortho programs.
     
    Silent Cool likes this.
  9. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Yeah, man Perio especially is crazy. I think almost all of those programs charge tuition, and it's three years. UPENN is basically 300K COA. So if you are 500K in the hole from DDS, then going to a private Perio program will leave you ~960K in debt.
     
  10. 011110

    011110 2+ Year Member

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    Yea, I could make 150k-200k right now as a GP, but my debt is not that high. As an ortho if I get in, I doubt my income would increase by much but I enjoy the work more. Not enough though to take out more loans. Unfortunately, more debt does not equal more income especially in this current day.
     
  11. DMD#03

    DMD#03

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    You also can consider income based loan repayment options. Once you get above 500k it really doesn't matter because you will end up having anything else forgiven. Pay as your earn is 10% of your AGI and the remaining is forgiven after 20yrs. If you count your residency during that time that's really only 16yrs or so of repayment. Tricky part is getting your AGI down as low as possible. My husband and I file separately, max out our 401ks, etc. I also put money aside every month for the final yr of my repayment plan since everything that is forgiven is considered income that year. After residency I will have about 700k of debt. But, I estimate monthly payments of about 1-2k for the next 16yrs and then about 500k (since interest still accrues) will be forgiven. Going to be crappy taxes that final year - but putting money aside for 16yrs will more then make-up.
     
  12. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    :barf:

    Ignoring the additional expense of opening a practice (another 400K, anyone?),
    if you have 700K of debt and pay only the minimum per year, then your balance will balloon to about 1.75 million dollars, assuming that eventually your income goes up to 350K. So if your income at year 20 is 375K, then you will owe about 850K of taxes. Taxes on 375K will leave you with about 225K, so you would need about 4 years of post tax income to pay the final year's tax. Not to mention the fact that saving/investing during the next 20 years will be very difficult because your practice will cost you as well. If you lease in a nice building (like the one my Orthodontist practices in), you will pay about 50K per year.

    This is insane.

    Looks like the beginning of the end for America, folks.
     
    Last edited: 10.01.14
    CraigHack and free99 like this.
  13. 011110

    011110 2+ Year Member

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    Yea PAYE is a good program if you trust politicians, which I don't. Plus, the government will never feel sympathy for the rich doctor. If I were you I would pay off that loan as quick as you can because simply put, politicians are lawyers. Lawyers hate doctors. They are not looking out for our interests.
     
    Silent Cool likes this.
  14. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Yeah, already the cronies in DC have tried to cut the PSLF program. What a bunch of BS.
     
  15. jeffdmdo

    jeffdmdo

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    Thanks Silent Cool for your advice!

    Are you a practicing ortho yourself? What makes you say it's worth it?
     
  16. jeffdmdo

    jeffdmdo

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    Actually... and even more interesting question since you seem to be good with playing numbers: at what price does ortho become not worth it (as in it starts to become such a burdensome loan)?
     
  17. navydentist

    navydentist

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    .
     
    Last edited: 11.23.15
  18. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Navy,

    Does this ortho have steady work? Is he booked just 1 day per week, for instance?

    I agree about patients wanting to pay you for the work--that is a major advantage, as well as the reduced physical stress. If the training were cheap (~150K), it would be a no brainer.

    thanx
     
  19. jeffdmdo

    jeffdmdo

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    Interesting... I wonder what charlestweed would say (I wish I could tag people... lol)
     
  20. Miley Cyrus.

    Miley Cyrus. Eat. Sleep. Twerk. 2+ Year Member

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    True, but aren't these patients also more difficult to please? From my experience (and also I think 'tweed mentioned this) these patients are much more likely to complain and also much more likely to sue if something goes wrong.
     
  21. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    You can:

    @charlestweed
     
  22. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Check out this Flickr photostream:

    'Put a face on the cost of a college education'

    Check out the guy in the second row, third from the left.

    https://www.flickr.com/photos/consumersunionoftheus/sets/72157629851738980/


    He's an orthodontist with 700K+ debt.

    WOW.

    Edit: sorry, forgot to post the link the first time.
     
    Last edited: 10.02.14
  23. navydentist

    navydentist

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    I think he works about 3-4 days/week. He's not very financially motivated.
     
  24. navydentist

    navydentist

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    Last edited: 11.23.15
  25. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    If he's getting that much from 4 days per week, then I'd say he's doing well. That's ~300K for 50 weeks per year.
     
  26. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Do you know how many cases per year he does? I read that the avg. is about 200 per year.

    If that's the case, then he's probably doing very well.
     
  27. BlueToothHunter

    BlueToothHunter 10+ Year Member

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    Don't forget that $1500 is GROSS. He is most likely going to be an independent contractor, so about 50% of that will be taxed for both CA and Federal.

     
  28. jeffdmdo

    jeffdmdo

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  29. charlestweed

    charlestweed 7+ Year Member

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    No, it doesn't matter where you get your orthodontic certificate from. Patients choose you because of your personality, your affordable fees, and most important of all, your clinical experiences. The more beautiful smiles that you create for your patients, the more people who will go around to tell their friends and relatives wonderful things about you. My practices get more new patients from word of mouth than from advertisement, walk-ins, and GP referrals combined. 5 years ago, I bought a dying practice from a Harvard trained orthodontist and none of the existing patients asked me where I graduated from. And I graduated from a very little known ortho program.

    Since you say you care about the lifestyle and having a life outside of work, then I think Ortho is the perfect specialty. The work is not stressful at all. You don't come home feeling exhausted even after you see 40-80 patients a day. You use your brain more than you use your hands and your back. You can still have plenty of energy to do things with your kids.

    It's harder to find associate jobs now than it was in the past but you actually get much higher daily rate now than in the past. The daily rate was $800 a day when I graduated. Now, the current rate is around $1000-1500 a day. To get more work days, you may have to drive farther, drive to more offices, and work on weekends. The salaries also vary greatly. Dental chains in CA pay very well. I've heard that associate jobs in the Northeast pay the least.

    I know you have a lot of student loans but you shouldn't rely solely on your associate jobs to pay down your debt. You have to start your own office. Having $110k in saving should put you ahead of many of your co-residents. It usually takes a new grad 3-4 years to save that amount. With this saving + your associate job income, you can start your own without borrowing more loan. Keep the overhead low and you will be fine.
     
  30. Greg_Jones

    Greg_Jones Dental Practice Acquisition Expert

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    I briefly skimmed this - I love how people came in here to bash you. You guys need to STOP worrying about your debt. There is nothing you can do about it! Look into the future and create a plan to become successful. As for your savings of 100K+, DO NOT use it to pay off your student loans or towards your practice. Personally, I would invest it into a roth IRA. Time is the number one asset to compounding interest. Talk with someone who knows their stuff and deals with investing for a living. I think they will tell you the same thing. Good luck and head up! Work as an associate for 2 or so years and pay off some of that debt.
     
  31. jeffdmdo

    jeffdmdo

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    Thanks so much you two! I'll definitely take heed of all of this advice as I move forward :D
     
  32. jeffdmdo

    jeffdmdo

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    Also, @charlestweed, are there any dental chains in particular you'd recommend?
     
  33. charlestweed

    charlestweed 7+ Year Member

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    All dental chains operate pretty much the same way. They care more about production and profit. They care more about quantity (ie start as many new cases as possible) than they do about quality of care. To increase the profit margin, they keep the overhead as low as possible and make their associate orthodontists treat as many patients in a day as possible. You should not let this deter you from seeking associate jobs at dental chains. IMO, you learn a lot more from working at dental chains than working at private ortho offices. Just take good care of your patients and everything should be fine. When I work at the chain, I treat the chain office as if it is my own office. I take good care of their patients just like I do with my patients at my own office. Like I said before, when you take good care of your patients, they will go around telling others about you. The more beautiful smiles you create, the more referrals you will get, and the more new cases you will start for the chain. That's how you make the chain owners happy. That's how you earn your bonus $$$ for starting a lot of new cases for them. That's how you avoid putting your license at risk. You don't need to over-treatment plan in order to increase the production.

    Working for a chain as an associate orthodontist is very different from working as an associate general dentist. There is a huge difference between using a cheap $50 PFM crown from a cheap lab and using an expensive $150 PFM crown from a high end lab. There is a huge difference between using used, dull, fragile endo files and using good, new, sharp endo files when doing an RCT. That's not true in ortho. You can still create beautiful smiles and make your patients happy without having to use expensive brackets and wires. You can still be an excellent orthodontist even when you work at a very poorly equipped chain office. The quality of care in ortho depends on your ability to diagnose and tx plan, and not on the type of brackets you use or type of clinic you work at. It's the painter and not the paint brush. You can make a bad chain office to become a good chain office. You can train a slow inexperienced ortho assistant to become a fast competent ortho assistant so he/she can take better care of your patients.
     
  34. jeffdmdo

    jeffdmdo

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    Thanks for your helpful advice and philosophy @charlestweed ! I do have a more explicit question(s) if you don't mind. Do you know how I can do a quick search into those CA dental chains you were talking about? Or could you pass along a few names of those chains? Google doesn't seem to be helping me out too much and I would like to see where these opportunities would be.

    Also, when you say traveling far - do you mean within a 1 hour/2 hour commute time? I guess it's just hard to imagine since I haven't even worked a day yet!
     

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