Ortho bubble about to pop?

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Georgia school of orthodontics is now accepting 36 kids per class. 36 kids in 1 class for almost 400k!!! This is like the housing bubble that is about to pop. Terrible for the future of the speciality.
Is all of dental education about to pop? We have a literal FOR PROFIT dental school opening up in California that answers to its shareholders.

Like I've mentioned, in the 80's the applicant pool for dental school dried up and several schools closed. Are we knocking on that door again? With the cost of attendance now exceeding $600,000 at more than a few schools, I'd say we are getting close.

Big Hoss
 
This is being fueled by the >1.5 TRILLION, of the publics money, that has been loaned to students pursuing higher education. The government has suspended interest rates (in real terms they're negative interests rates). Currently, the government is not even requiring repayment.

Yes, things are getting bad.
 
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Is all of dental education about to pop? We have a literal FOR PROFIT dental school opening up in California that answers to its shareholders.

Like I've mentioned, in the 80's the applicant pool for dental school dried up and several schools closed. Are we knocking on that door again? With the cost of attendance now exceeding $600,000 at more than a few schools, I'd say we are getting close.

Big Hoss

400K+600K to potentially become an orthodontist. Wow.
 
Here is an article that compares the cost of education and the ROI for an engineer and for an orthodontist. The author of this article assumed that an engineer can save $20k/year starting at 22 (right after college)….and the orthodontist has $1 million student loan debt and can save $150k/year starting at 29 (right after ortho residency). If the orthodontist pays back the student loans aggressively (in 10 years), it takes the orthodontist 16 years (or when they both turn 45) to catch up to an engineer.


Engineer v Ortho.png
 
Here is an article that compares the cost of education and the ROI for an engineer and for an orthodontist. The author of this article assumed that an engineer can save $20k/year starting at 22 (right after college)….and the orthodontist has $1 million student loan debt and can save $150k/year starting at 29 (right after ortho residency). If the orthodontist pays back the student loans aggressively (in 10 years), it takes the orthodontist 16 years (or when they both turn 45) to catch up to an engineer.


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This article mentions an assumption that the orthodontist saves 150k/year starting at age 29.

Have you found that to be true in your generation? I am almost certain it is not in mine. You would need to be making at least twice that amount, 300k to be able to do that.
 
This article mentions an assumption that the orthodontist saves 150k/year starting at age 29.

Have you found that to be true in your generation? I am almost certain it is not in mine. You would need to be making at least twice that amount, 300k to be able to do that.
Agreed. It is not simple to save that much per year. But it can be done. If you have a successful practice ..... you will be looking for any tax saving strategies to offest your tax penalty. Some what old fashioned, but early on .... I set up a profit sharing plan for myself and my staff administered by a 3rd party. It allowed me to put away pre-tax a large amount of money every year. I did this for many years. It makes up the bulk of my retirement assets.

Everyone needs to make a serious effort to start retirement savings. But it is tough. I had posted previously the difficulty in SAVING money. As you get older .... your expenses (personal) typically only go up. If you are single .... that's easier. But with a growing family. It is difficult to save money.

Also .... everyone hear is suggesting passive income. Well. That costs money, or worse you leverage yourself too much. Sometimes an investment works and sometime it doesn't. I won and lost. It will happen. It's all about TIMING.

Back to the ortho bubble. I can't speak for rural areas since I've practiced only in a saturated, desirable urban area for many years. To open an ortho private practice in a saturated area ..... it is getting tougher and tougher. There is SO MUCH competition for patients looking for braces, aligners. Private ortho practices. GP and Pedo practices offering ortho. Corp ortho is everywhere. DIY ortho. I don't see this with the other specialties. JUST ORTHO. When I graduated ... there were less than 300 new orthodontists graduating per year. I believe there is double that now (don't quote me lol). But that is still a small number.

Now the good. There is huge demand for orthodontic services. This will never change. With so many practices offering ortho services ..... there are PLENTY of high paying ortho jobs. PLENTY. It took my DSO employer almost 8 months before they could find two new orthos to hire. I've been constantly wined and dined to work for two other DSOs to fill in for their vacant ortho positions. One DSO wants to pay me more than I'm making now, but I would need to see more patients since they offer low fee braces. I'm not interested right now. I enjoy seeing fewer patients at higher fees.

So. Right now. The future is bright. Open a small private practice and a PT job at a DSO. Be diversified. As @charlestweed has said many times ..... open a low overhead office (skip the bells and whistles) and be willing to travel for a PT Corp job. You'll make plenty of money.

Oh. I almost forgot. KEEP THE DS, RESIDENCY DEBT LOW.
 
This article mentions an assumption that the orthodontist saves 150k/year starting at age 29.

Have you found that to be true in your generation? I am almost certain it is not in mine. You would need to be making at least twice that amount, 300k to be able to do that.
Yes, I made around $260-270k after I finished my ortho training at 29. Right after graduation, I worked 23 days/month for 3 different companies:

-Company A: 10 days/month. $800/day (+ 100-150/day in bonuses). I had to travel to 3 of their offices.
-Company B: 12 days/month. $950/day (no bonus). I had to travel to 2 of their offices.
-Company C: 1 day/month at a GP office. $900/day (no bonus). My boss is an orthodontist, who started in-house ortho services at several GP offices. He hired me to work at one of these GP offices.

Two years later, I got a new job offer from company D (Western Dental) for $1350/day, 12 days/month + a one-time $5k signing bonus. I gave company B my notice but they wanted me to stay by increasing my salary to $1200/day. I decided to stay at company B and quit companies A and C. Exactly 18 months later, when my contract with company D ended, company A asked me to come back to work for them full time and they offered me $1500/day with bonuses. I accepted Company A’s offer and I have worked for this company until now. At around this same time (in 2006), I started my first office. And a couple of years later, I opened 3 more satellite offices.

Now the new ortho grads get paid at least $1200-1300/day at most corp offices. If they are willing to travel to multiple offices and work 6 days/wk like what I did after graduation, they should bring home $350-400k/year, which is a lot more than what I made after graduation. The associate general dentists only made $300/day during my time. Today new grad GPs now make at least $550-600/day.

Although I made less than today new grads, I must admit that the purchasing power was much better during my time than it is now. I bought my first house for $400k. It’s now worth more than $1 million. I bought my second house for $921k. It is now worth $ 2 millions. I should have kept both of them. The MSRP for a brand new fully loaded 7 series BMW was only $70-80k….it is now at least $110k.
 
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Agreed. It is not simple to save that much per year.
Yeah, you don’t just put the money in the bank and collect a minuscule amount of interest every month. I saved just enough for 3-6 month living expenses. Whatever I made in excess every month went toward things like 401k, college saving for the kids, down payments for a house (and then for other investment properties), and paying down the debts. So I had pretty much been living paycheck to paycheck until February of this year, when I finally paid off my last debt, the home mortgage.
 
Agreed. It is not simple to save that much per year. But it can be done. If you have a successful practice ..... you will be looking for any tax saving strategies to offest your tax penalty. Some what old fashioned, but early on .... I set up a profit sharing plan for myself and my staff administered by a 3rd party. It allowed me to put away pre-tax a large amount of money every year. I did this for many years. It makes up the bulk of my retirement assets.

Everyone needs to make a serious effort to start retirement savings. But it is tough. I had posted previously the difficulty in SAVING money. As you get older .... your expenses (personal) typically only go up. If you are single .... that's easier. But with a growing family. It is difficult to save money.

Also .... everyone hear is suggesting passive income. Well. That costs money, or worse you leverage yourself too much. Sometimes an investment works and sometime it doesn't. I won and lost. It will happen. It's all about TIMING.

Back to the ortho bubble. I can't speak for rural areas since I've practiced only in a saturated, desirable urban area for many years. To open an ortho private practice in a saturated area ..... it is getting tougher and tougher. There is SO MUCH competition for patients looking for braces, aligners. Private ortho practices. GP and Pedo practices offering ortho. Corp ortho is everywhere. DIY ortho. I don't see this with the other specialties. JUST ORTHO. When I graduated ... there were less than 300 new orthodontists graduating per year. I believe there is double that now (don't quote me lol). But that is still a small number.

Now the good. There is huge demand for orthodontic services. This will never change. With so many practices offering ortho services ..... there are PLENTY of high paying ortho jobs. PLENTY. It took my DSO employer almost 8 months before they could find two new orthos to hire. I've been constantly wined and dined to work for two other DSOs to fill in for their vacant ortho positions. One DSO wants to pay me more than I'm making now, but I would need to see more patients since they offer low fee braces. I'm not interested right now. I enjoy seeing fewer patients at higher fees.

So. Right now. The future is bright. Open a small private practice and a PT job at a DSO. Be diversified. As @charlestweed has said many times ..... open a low overhead office (skip the bells and whistles) and be willing to travel for a PT Corp job. You'll make plenty of money.

Oh. I almost forgot. KEEP THE DS, RESIDENCY DEBT LOW.
I see scary threads like all doom and gloom about ortho, then I read posts like yours. Thinking OMS vs ortho right now. I'm doing Army first. Ortho sounds great, but, I don't want to get messed up with new grads being pumped out like crazy.
 
I see scary threads like all doom and gloom about ortho, then I read posts like yours. Thinking OMS vs ortho right now. I'm doing Army first. Ortho sounds great, but, I don't want to get messed up with new grads being pumped out like crazy.
Just be like 3/4 of my military friends and do endo when you get out. Hard to commoditize endo, as has happened to ortho. Trust me, you'll see plenty of endo on sick call in the military...

Big Hoss
 
Just be like 3/4 of my military friends and do endo when you get out. Hard to commoditize endo, as has happened to ortho. Trust me, you'll see plenty of endo on sick call in the military...

Big Hoss
Endo makes fat money...and fanfreakingtastic time off. It rivals OMFS pretty well in the money department from what I hear.
 
Stop trying to make me regret my specialty choice.

Big Hoss
Haha! Isn't endo literally able to choose how many days they work a month? I've heard OMFS can do that banging out production at corporate.
 
Endo makes fat money...and fanfreakingtastic time off. It rivals OMFS pretty well in the money department from what I hear.
All the big name specialties do well. You just have to figure out what you like (hate) most
 
All the big name specialties do well. You just have to figure out what you like (hate) most
I get told this a lot. I get the impression that dentists as a WHOLE seriously keep quiet about what the REAL salaries are. I feel like dentists are making boat loads of cash and they don't want people to truly know.
 
I get told this a lot. I get the impression that dentists as a WHOLE seriously keep quiet about what the REAL salaries are. I feel like dentists are making boat loads of cash and they don't want people to truly know.

the progression of an SDN thread

1. practicing young dentist states dissatisfaction with the way the field is progressing
2. Older dentists say they make tons of money and there is still money to be made
3. D1s and predents think said young dentists are lying and we secretly all make tons of cash
4. Administration smells the stink of irony and raises tuition and opens more programs to cash in on nativity of predents

and the cycle continues…
 
the progression of an SDN thread

1. practicing young dentist states dissatisfaction with the way the field is progressing
2. Older dentists say they make tons of money and there is still money to be made
3. D1s and predents think said young dentists are lying and we secretly all make tons of cash
4. Administration smells the stink of irony and raises tuition and opens more programs to cash in on nativity of predents

and the cycle continues…
It doesn't take much to think doing a root canal or removing a third molar, considering the cost of each, taking rough consideration of taxes and overhead into account, and seeing that this dentistry concept makes large sums of cheddar well above a 300k average salary that gets mentioned.
 
I get told this a lot. I get the impression that dentists as a WHOLE seriously keep quiet about what the REAL salaries are. I feel like dentists are making boat loads of cash and they don't want people to truly know.
It doesn't take much to think doing a root canal or removing a third molar, considering the cost of each, taking rough consideration of taxes and overhead into account, and seeing that this dentistry concept makes large sums of cheddar well above a 300k average salary that gets mentioned.

Correct. Just don’t associate forever.
 
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There is so much good quality CE for Endo, Oral Surgery, Orthodontics, and Implants that the time/cost of residency is just not worth it. In todays economy you don't want to limit yourself to just one set of procedures. Ortho residency specially, Most dental offices are doing ortho inhouse specially with aligner therapy farmed out to assistants.
 
There is so much good quality CE for Endo, Oral Surgery, Orthodontics, and Implants that the time/cost of residency is just not worth it. In todays economy you don't want to limit yourself to just one set of procedures. Ortho residency specially, Most dental offices are doing ortho inhouse specially with aligner therapy farmed out to assistants.

How much does good quality CE cost for Orthodontics vs. going to a residency for Ortho?

Depending on who you ask, I'm sure the answer will differ, but anyone feel free to answer:
In your opinion, what is better to do - good quality CE ortho as a general dentist or becoming an orthodontist?
 
There is so much good quality CE for Endo, Oral Surgery, Orthodontics, and Implants that the time/cost of residency is just not worth it. In todays economy you don't want to limit yourself to just one set of procedures. Ortho residency specially, Most dental offices are doing ortho inhouse specially with aligner therapy farmed out to assistants.
I'm still in school so I really don't know anything about CE. How can CE be as good as actually attending a residency at a hospital for OMS?
 
There is so much good quality CE for Endo, Oral Surgery, Orthodontics, and Implants that the time/cost of residency is just not worth it. In todays economy you don't want to limit yourself to just one set of procedures. Ortho residency specially, Most dental offices are doing ortho inhouse specially with aligner therapy farmed out to assistants.

In today's economy, you certainly do want to limit yourself to one set of procedures that are highly lucrative. You stop doing low-hanging fruit procedures and just focus on referrals for better paying procedures.
 
There is no CE class out there that can replace a piece of paper that certifies that you completed a formal residency training….AKA an ortho certificate. In order to get paid the big bucks at corp offices, you have to have an ortho certificate. The average pay for associate orthodontists at most corp offices is around $1200-1300 a day, which is 2-3 times more than the daily pay of associate general dentists….and is probably more than what many GP owners make. And workload is much less…..the ortho assistants do most of the hard work.

If you are a GP who does ortho, the only source of new patients that you can get is from your own office, which is not enough to keep you busy. When you don’t have enough ortho patients, you cannot afford to hire an ortho assistant and you have you do all the hard work yourself. If you have to do all the ortho adjustments by yourself and you have to spend at least 30 minutes to an hour to work on each patient by yourself every month, then ortho is no longer a fun thing to do…..then doing ortho is not very profitable. You probably make more per hour when you cut a crown prep than spending 2 years (at least 18-24 regular office visits + some emergency loose bracket office visits) to treat an ortho patient.
 
There is no CE class out there that can replace a piece of paper that certifies that you completed a formal residency training….AKA an ortho certificate. In order to get paid the big bucks at corp offices, you have to have an ortho certificate. The average pay for associate orthodontists at most corp offices is around $1200-1300 a day, which is 2-3 times more than the daily pay of associate general dentists….and is probably more than what many GP owners make. And workload is much less…..the ortho assistants do most of the hard work.

If you are a GP who does ortho, the only source of new patients that you can get is from your own office, which is not enough to keep you busy. When you don’t have enough ortho patients, you cannot afford to hire an ortho assistant and you have you do all the hard work yourself. If you have to do all the ortho adjustments by yourself and you have to spend at least 30 minutes to an hour to work on each patient by yourself every month, then ortho is no longer a fun thing to do…..then doing ortho is not very profitable. You probably make more per hour when you cut a crown prep than spending 2 years (at least 18-24 regular office visits + some emergency loose bracket office visits) to treat an ortho patient.
I also want to point out, I worked as an assistant in both an ortho office and a general office that did clear aligners. The quality of the clear aligner therapy at the general office was not even close to that at the ortho office. CE courses do not give you the amount of information needed on tooth movement and physics etc that is needed to have really successful clear aligner therapy.

The ortho office I worked at, maybe 10%-15% invis patients needed a refinement scan at some point in their tx, and that was usually just either the pt or the ortho being picky. At the GP office I worked at, pretty much every patient did. They eventually got the results they wanted but it took probably 2x as long as at the ortho office.

I am currently applying/interviewing for ortho programs and this ^^ is all i can think about when I see people saying ortho will be dead soon due to clear aligner in GP offices becoming more widespread.
 
I also want to point out, I worked as an assistant in both an ortho office and a general office that did clear aligners. The quality of the clear aligner therapy at the general office was not even close to that at the ortho office. CE courses do not give you the amount of information needed on tooth movement and physics etc that is needed to have really successful clear aligner therapy.

The ortho office I worked at, maybe 10%-15% invis patients needed a refinement scan at some point in their tx, and that was usually just either the pt or the ortho being picky. At the GP office I worked at, pretty much every patient did. They eventually got the results they wanted but it took probably 2x as long as at the ortho office.

I am currently applying/interviewing for ortho programs and this ^^ is all i can think about when I see people saying ortho will be dead soon due to clear aligner in GP offices becoming more widespread.
Yep. I think ortho diagnosis can be hard enough with a residency let alone just taking CE. You don’t know what you don’t know.
 
There is no CE class out there that can replace a piece of paper that certifies that you completed a formal residency training….AKA an ortho certificate. In order to get paid the big bucks at corp offices, you have to have an ortho certificate. The average pay for associate orthodontists at most corp offices is around $1200-1300 a day, which is 2-3 times more than the daily pay of associate general dentists….and is probably more than what many GP owners make. And workload is much less…..the ortho assistants do most of the hard work.

If you are a GP who does ortho, the only source of new patients that you can get is from your own office, which is not enough to keep you busy. When you don’t have enough ortho patients, you cannot afford to hire an ortho assistant and you have you do all the hard work yourself. If you have to do all the ortho adjustments by yourself and you have to spend at least 30 minutes to an hour to work on each patient by yourself every month, then ortho is no longer a fun thing to do…..then doing ortho is not very profitable. You probably make more per hour when you cut a crown prep than spending 2 years (at least 18-24 regular office visits + some emergency loose bracket office visits) to treat an ortho patient.
Comment on pay: I guess that depends on where you are? In SoCal I make a tad over $900 per day working as a GP before bonus. I've only been out of school for a few years. I guess my bargaining chip is that I see a lot of peds patients that the other docs don't want to see... But, I am making pretty close (or more in one case) to my classmates that have their ortho certificates.

I'm not arguing with your point but I think that the field is changing for GPs faster than people might think. Don't get me wrong - the average orthodontist makes more than the average GP; however, those bell curves overlap a lot more than is being stated above.
 
Comment on pay: I guess that depends on where you are? In SoCal I make a tad over $900 per day working as a GP before bonus. I've only been out of school for a few years. I guess my bargaining chip is that I see a lot of peds patients that the other docs don't want to see... But, I am making pretty close (or more in one case) to my classmates that have their ortho certificates.

I'm not arguing with your point but I think that the field is changing for GPs faster than people might think. Don't get me wrong - the average orthodontist makes more than the average GP; however, those bell curves overlap a lot more than is being stated above.
Yeah, I was talking about the average pays of GPs vs orthos. Some associate GPs get paid based on the % of the production and make over $1000 a day. Some orthos at the Corp get the guaranteed daily pay + bonus (base on production or number of starts) and make over $2k a day. The workload and stress level are much lower for an orthodontist. That’s why many of them work past their retirement age….and it’s not because they need the money. It’s something for them to do to keep them busy. Many people feel depressed after they retire because they run out of things to do.
 
Yeah, I was talking about the average pays of GPs vs orthos. Some associate GPs get paid based on the % of the production and make over $1000 a day. Some orthos at the Corp get the guaranteed daily pay + bonus (base on production or number of starts) and make over $2k a day. The workload and stress level are much lower for an orthodontist. That’s why many of them work past their retirement age….and it’s not because they need the money. It’s something for them to do to keep them busy. Many people feel depressed after they retire because they run out of things to do.
Maybe it's my smaller sample size but the four ortho offices in my area have huge workloads and I'm close with each of them and those orthodontists are very stressed.

I see what you mean about production vs base pay - that would make a huge difference with stress. I'm glad I found an office that pays a base, I would hate having to worry about production... That probably cuts down my stress quite a bit.

I just think that the ortho profession is changing and will continue to change over the next few years. Average salary will go down overtime without a significant increase in production and stress. I don't think the bubble is going to "pop" per se but the amount of grads pumping out (and only increasing as time goes on) plus the amount of GPs that are doing their own cases... Ortho will have to adjust a lot to keep the landscape you're describing in your post.
 
Maybe it's my smaller sample size but the four ortho offices in my area have huge workloads and I'm close with each of them and those orthodontists are very stressed.

I see what you mean about production vs base pay - that would make a huge difference with stress. I'm glad I found an office that pays a base, I would hate having to worry about production... That probably cuts down my stress quite a bit.

I just think that the ortho profession is changing and will continue to change over the next few years. Average salary will go down overtime without a significant increase in production and stress. I don't think the bubble is going to "pop" per se but the amount of grads pumping out (and only increasing as time goes on) plus the amount of GPs that are doing their own cases... Ortho will have to adjust a lot to keep the landscape you're describing in your post.
It’s good that all of the ortho offices in your area are busy. I wish I have this huge workload problem at my own offices so I don’t need to work part time at the corp to fill my 5 day/wk work schedule. It’s actually more stressful when your office doesn’t have enough patients. The amount of work in ortho depends on how you book your patients. Some orthodontists want to take it easy and only see 20-30 patients a day. That would be too slow and too boring for me….. I want to see 60-90 patients a day. When I was younger (in my mid 30s), I saw 100+ patients a day. The stress level decreases over time as you gain more clinical experience and treat enough complicated cases. When I was a recent grad, I was so slow and stressed out all the time due to the high volume of patients that I had to see at the corp office. Now with the experience, everything becomes so easy. I have to bring my laptop to entertain myself because the workload at the corp is very light, especially in the morning when most of my teenaged patients are at schools. It’s much busier at my own office because I book the same amount of patients in 4 hours, instead of 8 hours.
 
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I'm still in school so I really don't know anything about CE. How can CE be as good as actually attending a residency at a hospital for OMS?
Plenty of Hands On workshops and CE that get you comfortable. Its up to you to research, study and practice. Some providers need to be babysat in hospital residency or if you want to become full on OMFS. Every provider is different and risk profile is also different. I started placing implants after my first hands-on Implant course and I have been doing them for years. Same for ortho, and I do bracket and wire. If GPs realized how easy ortho is the whole Ortho field would be out of business. I think GPs should be doing the easy-medium difficulty cases for Ortho. Just like Endo and Oral Surgery. Just refer to Ortho the really hard cases just like you do for other specialists.

In today's economy, you certainly do want to limit yourself to one set of procedures that are highly lucrative. You stop doing low-hanging fruit procedures and just focus on referrals for better paying procedures.

Maybe, but then I see all the specialists traveling from office to office begging GPs for their referrals. Its quite pathetic honestly. Our OS travels from out of state and I pity him at times because he just gets stuck with the worst patients

There is no CE class out there that can replace a piece of paper that certifies that you completed a formal residency training….AKA an ortho certificate. In order to get paid the big bucks at corp offices, you have to have an ortho certificate. The average pay for associate orthodontists at most corp offices is around $1200-1300 a day, which is 2-3 times more than the daily pay of associate general dentists….and is probably more than what many GP owners make. And workload is much less…..the ortho assistants do most of the hard work.

If you are a GP who does ortho, the only source of new patients that you can get is from your own office, which is not enough to keep you busy. When you don’t have enough ortho patients, you cannot afford to hire an ortho assistant and you have you do all the hard work yourself. If you have to do all the ortho adjustments by yourself and you have to spend at least 30 minutes to an hour to work on each patient by yourself every month, then ortho is no longer a fun thing to do…..then doing ortho is not very profitable. You probably make more per hour when you cut a crown prep than spending 2 years (at least 18-24 regular office visits + some emergency loose bracket office visits) to treat an ortho patient.

This is True! But most GPs are more than capable to do easy-medium difficulty Orthodontic cases at competitive prices. I do my own bonding and I can bond a whole cases in 40 minutes or so including IPR. A bond appointment is $1500 down which is more than what a crown prep is....and to be honest is way more fun. I enjoy doing ortho and what it does for my practice, also the assistants are trained to change wires and ties. Its pretty no brainer compared to operative. PPOs still pay GPs for orthodontics and the only advantage I see is having access to the Medicaid pool of patients....which no one really wants to do. But yes, a GP doesn't have the knowledge or training that an specialist does, however; there are plenty of GPs that do good work and have amazing results.

Would you send your family there for ortho tx?
No, but most people DO, which is my point. Most of the public is unsuspecting and they pay for treatment behind Invisilign and ClearCorrect...etc.
 
This is True! But most GPs are more than capable to do easy-medium difficulty Orthodontic cases at competitive prices. I do my own bonding and I can bond a whole cases in 40 minutes or so including IPR. A bond appointment is $1500 down which is more than what a crown prep is....and to be honest is way more fun. I enjoy doing ortho and what it does for my practice, also the assistants are trained to change wires and ties. Its pretty no brainer compared to operative. PPOs still pay GPs for orthodontics and the only advantage I see is having access to the Medicaid pool of patients....which no one really wants to do. But yes, a GP doesn't have the knowledge or training that an specialist does, however; there are plenty of GPs that do good work and have amazing results.
It’s good that you enjoy doing ortho and have the experienced assistants to help you. It wouldn’t be fun if you have to do most of the work yourself. It’s good that your patients are willing to put $1500 for down payment. Most of my patients don’t have that kind of money in the bank. Many of them are living paycheck to paycheck. My offices would have a hard time getting the new patients to accept treatments, if we required such large down payment amount. And the referring GPs would stop sending their patients to my office if most of the patients, whom they refer to, couldn’t afford ortho tx at my office.

If you have available time slot to treat ortho patients in your GP practice, then why not do it? I would do it too if I were a GP. It’s better than sitting around doing nothing.
 
Maybe, but then I see all the specialists traveling from office to office begging GPs for their referrals. Its quite pathetic honestly. Our OS travels from out of state and I pity him at times because he just gets stuck with the worst patients
Don’t feel sorry for these specialists. They make a lot for each procedure that they perform. My wife’s co-resident used fly to Las Vegas (from San Diego) and he placed a ton of implants and performed other perio-related procedures when he was there 2-3 days a month. For those 2-3 days in Vegas, he made close to what my wife made in a month in CA. Everything in life is a trade off. You have to give up something (borrowing more loans for residency trainings, begging the GPs for referrals, flying in from another state) in order to gain something.

It takes you 40 minutes to do a full mouth bonding. It'd probably take me the same amount of time if I didn't have an assistant. With an experienced ortho assistant in my practice, it only takes me 2-3 minutes to do a full mouth bonding. The assistant helps prepare everything for me. I only need to come in to position the brackets and the assistant light cures the adhesive for me. That's how I can handle high volume of patients in a day and have a productive day.
 
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Si senor!
Don’t feel sorry for these specialists. They make a lot for each procedure that they perform. My wife’s co-resident used fly to Las Vegas (from San Diego) and he placed a ton of implants and performed other perio-related procedures when he was there 2-3 days a month. For those 2-3 days in Vegas, he made close to what my wife made in a month in CA. Everything in life is a trade off. You have to give up something (borrowing more loans for residency trainings, begging the GPs for referrals, flying in from another state) in order to gain something.

It takes you 40 minutes to do a full mouth bonding. It'd probably take me the same amount of time if I didn't have an assistant. With an experienced ortho assistant in my practice, it only takes me 2-3 minutes to do a full mouth bonding. The assistant helps prepare everything for me. I only need to come in to position the brackets and the assistant light cures the adhesive for me. That's how I can handle high volume of patients in a day and have a productive day.
I charge much cheaper than the local guys but I do require a bigger down payment. Everything IS a trade off indeed. I find that if you dont have $1000-1500 to put towards braces then you are not really serious about them. Most ortho assistants will know how to position brackets, usually the orthodontist will go and refine position before curing but a good assistant will take you over 95% to finish line. Thats how you can do 15-20 starts in 1 day. I used to work at a practice that the Orthodontist used to do 30-40 Medicaid cases starts every day....he was sitting at his desk all day. You sir are living the deam!
 
There're certain areas in dentistry where a GP can have a niche where no other specialty can touch (except for prostho), and you can avoid doing simple fillings and cleanings, while performing highly productive procedures.

Check out Sam Saleh and Thomas Connelly on instagram. They make a killing doing crowns and veneers, and their income surpasses most specialists'. Anyone see Post Malone's post/core/crown diamond canines? Connelly charged him 1.6 million.
 
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There is no CE class out there that can replace a piece of paper that certifies that you completed a formal residency training….AKA an ortho certificate. In order to get paid the big bucks at corp offices, you have to have an ortho certificate. The average pay for associate orthodontists at most corp offices is around $1200-1300 a day, which is 2-3 times more than the daily pay of associate general dentists….and is probably more than what many GP owners make. And workload is much less…..the ortho assistants do most of the hard work.

If you are a GP who does ortho, the only source of new patients that you can get is from your own office, which is not enough to keep you busy. When you don’t have enough ortho patients, you cannot afford to hire an ortho assistant and you have you do all the hard work yourself. If you have to do all the ortho adjustments by yourself and you have to spend at least 30 minutes to an hour to work on each patient by yourself every month, then ortho is no longer a fun thing to do…..then doing ortho is not very profitable. You probably make more per hour when you cut a crown prep than spending 2 years (at least 18-24 regular office visits + some emergency loose bracket office visits) to treat an ortho patient.

Waaaaait. GP owners make way more than $1200-1300 a day. If I make that much in less than a year as an associate, then I'm definitely not doing my job well.
 
Waaaaait. GP owners make way more than $1200-1300 a day. If I make that much in less than a year as an associate, then I'm definitely not doing my job well.
GP owners in other states probably make a lot more. But here in CA, if a GP owner can net around $1200-1300 a day (or having a consistent gross production of $2400-2600 a day), he/she is considered to be a very successful dentist. If he/she works 22 days/month, his net annual income should be around $325-350k/year. If a dentist owner can net that much, then having a student loan debt of $500-600k shouldn’t be a big issue. He/she should be able to catch up to an engineer, who has zero debt and a 4-year head start, in a few years.
 
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I feel this is why ortho is taught at the theoretical level only in dental school. They keep the practical aspect hidden, only to be unlocked for those in residency.

Big Hoss

Ortho is different than all other areas of dentistry.
Reason? Ortho tx is performed over a long period of time. The success of your tx depends on a proper diagnosis. Proper mechanics. Favorable growth pattern. Proper retention. When you are learning ortho in school .... it is near impossible to understand the dynamics of successful orthodontic treatment without years of experience. Seriously. It's hard enough for new ortho grads to understand ortho since most do not have experience.

Do GP graduates really learn enough about ortho other than ordering aligners, placing attachments, doing some IPR and handing out trays? Uh oh. Teeth aren't straight. Better do a refinement and get more trays. More trays is always the answer because that is all a GP has. Does the patient need more trays or maybe a better initial diagnosis of WHY the malocclusion exists in the 1st place.

What's the old saying? There's more to straightening teeth than "straightening teeth". My favorite. You only know what YOU know and what GPs know about ortho is very little.

Patients are very accepting of their ortho tx. What I know for a fact is that patients cannot discern the difference between quality ortho tx and average ortho tx. If the front teeth are straight .... patients are happy. I KNOW the difference as an orthodontist. Aligner companies. GPs doing ortho/aligners are treating these unknowledgeable patients. They're led to believe that straightening teeth is the same everywhere.

You're a new GP struggling to pay your DS debt and practice debt. You offer Invisalign because of the PRODUCTION. The need for PRODUCTION. Seriously. Your patients TRUST you to help them make the right decision on their tx. You're a competent general dentist because most of your training was in general dentistry. Are you competent in treating an aligner case? Will the outcome be a stable ortho result that will last a lifetime?
 
Ortho is different than all other areas of dentistry.
Reason? Ortho tx is performed over a long period of time. The success of your tx depends on a proper diagnosis. Proper mechanics. Favorable growth pattern. Proper retention. When you are learning ortho in school .... it is near impossible to understand the dynamics of successful orthodontic treatment without years of experience. Seriously. It's hard enough for new ortho grads to understand ortho since most do not have experience.

Do GP graduates really learn enough about ortho other than ordering aligners, placing attachments, doing some IPR and handing out trays? Uh oh. Teeth aren't straight. Better do a refinement and get more trays. More trays is always the answer because that is all a GP has. Does the patient need more trays or maybe a better initial diagnosis of WHY the malocclusion exists in the 1st place.

What's the old saying? There's more to straightening teeth than "straightening teeth". My favorite. You only know what YOU know and what GPs know about ortho is very little.

Patients are very accepting of their ortho tx. What I know for a fact is that patients cannot discern the difference between quality ortho tx and average ortho tx. If the front teeth are straight .... patients are happy. I KNOW the difference as an orthodontist. Aligner companies. GPs doing ortho/aligners are treating these unknowledgeable patients. They're led to believe that straightening teeth is the same everywhere.

You're a new GP struggling to pay your DS debt and practice debt. You offer Invisalign because of the PRODUCTION. The need for PRODUCTION. Seriously. Your patients TRUST you to help them make the right decision on their tx. You're a competent general dentist because most of your training was in general dentistry. Are you competent in treating an aligner case? Will the outcome be a stable ortho result that will last a lifetime?
As you said, as long as the GP delivers on the “social six,” most patients won’t care about anything else in their treatment. This mentality fosters a race to the bottom, unfortunately. That said, I’d personally prefer my kids be seen by an ortho rather than GP. But that’s because I appreciate what a trained ortho can do. Maybe if I ever move to AZ or CA I’ll have to look you up or a certain @charlestweed.

Big Hoss
 
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Ortho is different than all other areas of dentistry.
Reason? Ortho tx is performed over a long period of time. The success of your tx depends on a proper diagnosis. Proper mechanics. Favorable growth pattern. Proper retention. When you are learning ortho in school .... it is near impossible to understand the dynamics of successful orthodontic treatment without years of experience. Seriously. It's hard enough for new ortho grads to understand ortho since most do not have experience.

Do GP graduates really learn enough about ortho other than ordering aligners, placing attachments, doing some IPR and handing out trays? Uh oh. Teeth aren't straight. Better do a refinement and get more trays. More trays is always the answer because that is all a GP has. Does the patient need more trays or maybe a better initial diagnosis of WHY the malocclusion exists in the 1st place.

What's the old saying? There's more to straightening teeth than "straightening teeth". My favorite. You only know what YOU know and what GPs know about ortho is very little.

Patients are very accepting of their ortho tx. What I know for a fact is that patients cannot discern the difference between quality ortho tx and average ortho tx. If the front teeth are straight .... patients are happy. I KNOW the difference as an orthodontist. Aligner companies. GPs doing ortho/aligners are treating these unknowledgeable patients. They're led to believe that straightening teeth is the same everywhere.

You're a new GP struggling to pay your DS debt and practice debt. You offer Invisalign because of the PRODUCTION. The need for PRODUCTION. Seriously. Your patients TRUST you to help them make the right decision on their tx. You're a competent general dentist because most of your training was in general dentistry. Are you competent in treating an aligner case? Will the outcome be a stable ortho result that will last a lifetime?
Ortho is NOT different. This is the same delusion all specialists have about their area. Endodontists swear that all teeth not done under a microscope and under rubberdam will fail. Periodontists/OS swear that they have to place all implants for them to be successful and have long term prognosis.

The flip side is that there are good and bad orthodontists out there. I will take a GP with a few years of ortho experience over a new ortho grad...anyday. What quality do you get from a practice that sees 100+ patients a day, where brackets are bonded by an underpaid assistants. I have seen the quality of ortho mills, I have seen the overexpansion of cases and damage that is downright shameful. But oh no....it was done by the "orthodontist".

You are right, patients are very accepting of their ortho treatment.
 
Ortho is NOT different. This is the same delusion all specialists have about their area. Endodontists swear that all teeth not done under a microscope and under rubberdam will fail. Periodontists/OS swear that they have to place all implants for them to be successful and have long term prognosis.

The flip side is that there are good and bad orthodontists out there. I will take a GP with a few years of ortho experience over a new ortho grad...anyday. What quality do you get from a practice that sees 100+ patients a day, where brackets are bonded by an underpaid assistants. I have seen the quality of ortho mills, I have seen the overexpansion of cases and damage that is downright shameful. But oh no....it was done by the "orthodontist".

You are right, patients are very accepting of their ortho treatment.
This made me laugh
 
Ortho is NOT different. This is the same delusion all specialists have about their area. Endodontists swear that all teeth not done under a microscope and under rubberdam will fail. Periodontists/OS swear that they have to place all implants for them to be successful and have long term prognosis.

The flip side is that there are good and bad orthodontists out there. I will take a GP with a few years of ortho experience over a new ortho grad...anyday. What quality do you get from a practice that sees 100+ patients a day, where brackets are bonded by an underpaid assistants. I have seen the quality of ortho mills, I have seen the overexpansion of cases and damage that is downright shameful. But oh no....it was done by the "orthodontist".

You are right, patients are very accepting of their ortho treatment.
While of course there are variations in skill levels, and graduating from residency doesn't make you a master, this is my opinion:

I will take a new grad specialist over a new grad GP any day.

I will take an experienced specialist over an experienced GP any day.
 
Ortho is NOT different. This is the same delusion all specialists have about their area. Endodontists swear that all teeth not done under a microscope and under rubberdam will fail. Periodontists/OS swear that they have to place all implants for them to be successful and have long term prognosis.

The flip side is that there are good and bad orthodontists out there. I will take a GP with a few years of ortho experience over a new ortho grad...anyday. What quality do you get from a practice that sees 100+ patients a day, where brackets are bonded by an underpaid assistants. I have seen the quality of ortho mills, I have seen the overexpansion of cases and damage that is downright shameful. But oh no....it was done by the "orthodontist".

You are right, patients are very accepting of their ortho treatment.
Some of your points are correct. There are bad and good everywhere regardless if generalist or specialist. But common sense should prevail here. You can't argue that those who became specialists worked a "little harder" in dental school to obtain the necessary credentials to attend a residency. You can't argue that most specialists attended 2-3 years of accredited education taught by mostly board certified academicians. You can't argue that ALL specialists do ONE thing. All the time. Every day. Every hour.

Even with all those credentials. Yes. You are right. There are some bad examples of specialists out there. I've seen it 1st hand at the Corp I work at. But for every "bad" specialist .... there is probably a hundred fold bad GPs out there doing poor quality dental work.

Patients trust their doctors (dentists) to make the right decisions. If you are quite capable of performing a certain procedure ... then it's YOUR choice to perform it. As long as the patient benefits from that decision.
 
GP owners in other states probably make a lot more. But here in CA, if a GP owner can net around $1200-1300 a day (or having a consistent gross production of $2400-2600 a day), he/she is considered to be a very successful dentist.
Those are some pretty conservative numbers man. Those numbers mean less than 2 crowns a day. IMHO, $2600 production per day is very far from the very successful land, especially as an owner.
 
Those are some pretty conservative numbers man. Those numbers mean less than 2 crowns a day. IMHO, $2600 production per day is very far from the very successful land, especially as an owner.
I know you are in northern California. Maybe you can charge higher tx fees up there. Perhaps, it’s less saturated up there. But here in SoCal, if you charge your patient $1300 a crown and you sucessfully convince him/her to accept the tx, you must be a very good business person. That’s because there are a lot of offices (private and Corp offices) in the area that are willing to do a crown for much less. There are certain insurance plans that don't pay you that much for a crown.

Any average dentist is capable of doing 3-4 crown preps a day and producing $5-6k a day. The problem is the supply of patients here in SoCal is very limited. A lot of dental offices don’t have enough patients to fill their appt books. Corp offices are also struggling to get the patients to come in for tx. There are a lot of slow days that the dentist owners don’t even have a crown prep to do…..unless they over-treatment plan (by turning every MOD filling into a crown). Many dentist owners have to do their own cleanings to keep themselves busy. Many owners can only afford to hire 1 assistant, who can work both front and back, due to slow business.

The GP owner, whom I currently rent an office space from, only has 1 assistant. There are only enough patients to keep him busy 4-5 hours a day. On some days, he only has 2-3 patients. The good thing is he owns the building (he bought it for only $600k during the 2008 housing buble...and paid it in full).....and he collects the monthly rent payments from me.

If an average GP owner can easily net $300-350k/year, then why do we see so many threads on this forum telling the predents not to pursue dentistry? If one can make that much, then having $500-600k student loan debt shouldn't be an issue.
 
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I know you are in northern California. Maybe you can charge higher tx fees up there. Perhaps, it’s less saturated up there. But here in SoCal, if you charge your patient $1300 a crown and you sucessfully convince him/her to accept the tx, you must be a very good business person. That’s because there are a lot of offices (private and Corp offices) in the area that are willing to do a crown for much less. There are certain insurance plans that don't pay you that much for a crown.

Any average dentist is capable of doing 3-4 crown preps a day and producing $5-6k a day. The problem is the supply of patients here in SoCal is very limited. A lot of dental offices don’t have enough patients to fill their appt books. Corp offices are also struggling to get the patients to come in for tx. There are a lot of slow days that the dentist owners don’t even have a crown prep to do…..unless they over-treatment plan (by turning every MOD filling into a crown). Many dentist owners have to do their own cleanings to keep themselves busy. Many owners can only afford to hire 1 assistant, who can work both front and back, due to slow business.

The GP owner, whom I currently rent an office space from, only has 1 assistant. There are only enough patients to keep him busy 4-5 hours a day. On some days, he only has 2-3 patients. The good thing is he owns the building (he bought it for only $600k during the 2008 housing buble...and paid it in full).....and he collects the monthly rent payments from me.

If an average GP owner can easily net $300-350k/year, then why do we see so many threads on this forum telling the predents not to pursue dentistry? If one can make that much, then having $500-600k student loan debt shouldn't be an issue.
Don't live in California
 
Don't live in California
Nah, there are so many good things in CA that many Californians cannot give up. There’s no point of making a lot of money if you don’t spend your money…if you have to live in a place where you don’t enjoy living there 365 days/year.

 
Nah, there are so many good things in CA that many Californians cannot give up. There’s no point of making a lot of money if you don’t spend your money…if you have to live in a place where you don’t enjoy living there 365 days/year.

Second that

I know you are in northern California. Maybe you can charge higher tx fees up there. Perhaps, it’s less saturated up there. But here in SoCal, if you charge your patient $1300 a crown and you sucessfully convince him/her to accept the tx, you must be a very good business person. That’s because there are a lot of offices (private and Corp offices) in the area that are willing to do a crown for much less. There are certain insurance plans that don't pay you that much for a crown.

Any average dentist is capable of doing 3-4 crown preps a day and producing $5-6k a day. The problem is the supply of patients here in SoCal is very limited. A lot of dental offices don’t have enough patients to fill their appt books. Corp offices are also struggling to get the patients to come in for tx. There are a lot of slow days that the dentist owners don’t even have a crown prep to do…..unless they over-treatment plan (by turning every MOD filling into a crown). Many dentist owners have to do their own cleanings to keep themselves busy. Many owners can only afford to hire 1 assistant, who can work both front and back, due to slow business.

The GP owner, whom I currently rent an office space from, only has 1 assistant. There are only enough patients to keep him busy 4-5 hours a day. On some days, he only has 2-3 patients. The good thing is he owns the building (he bought it for only $600k during the 2008 housing buble...and paid it in full).....and he collects the monthly rent payments from me.

If an average GP owner can easily net $300-350k/year, then why do we see so many threads on this forum telling the predents not to pursue dentistry? If one can make that much, then having $500-600k student loan debt shouldn't be an issue.
SF Bay Area is pretty saturated. I have clients in SoCal that do very well, however, it's a different market, I agree.
 
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