ortho post interview thoughts

[bentwires5]

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So I had interviews at quite a few programs. I applied to 12 programs

I hope this is helpful for anyone

Washington Hospital center was by far the worst clinic experience of all my programs and does not even have enough chairs for each resident. I don’t care its paid you will not learn enough ortho there to practice on your own.

Pitt was very weak as well they have a very weak clinic there. The residents seemed more interested in having fun then learning ortho… you pay all that money to get very little experience

Temple seemed to have an ok clinic but very unfriendly staff and not an environment I would like to work in. horrible location very unsafe.

Louisville and Ohio state were very similar with ohio state being longer but very friendly with strong clinic

UNC and Mich were very similar they want to see you research but will also teach you everything about ortho and all the different treatment options.

I was at Houston and Baylor I really liked both these programs being from Florida I wouldn’t mind being in the south. I think that Baylor is a very strong program the staff and residents seemed very happy.

My rank list is:

1. Baylor

2. Mich

3. Ohio State

4. Houston

5. Louisville

6. UNC

7. NOVA my home school

I will not be ranking Washington Hospital Center, Pitt or Temple

I have declined an invite from Colorado

 

[lwen5]

You formed an account just to post this? Quite suspicious. I think Washington, Pitt and Temple are your top preferences. You want people to rank it lower or not apply. Am I right?

 

[gryffindor]

One has nothing to gain but everything to lose by not ranking a program.

Residency is what you make of it.

 

[hopefullyortho]

So I had interviews at quite a few programs. I applied to 12 programs

I hope this is helpful for anyone

Washington Hospital center was by far the worst clinic experience of all my programs and does not even have enough chairs for each resident. I don’t care its paid you will not learn enough ortho there to practice on your own.

Pitt was very weak as well they have a very weak clinic there. The residents seemed more interested in having fun then learning ortho… you pay all that money to get very little experience

Temple seemed to have an ok clinic but very unfriendly staff and not an environment I would like to work in. horrible location very unsafe.

Louisville and Ohio state were very similar with ohio state being longer but very friendly with strong clinic

UNC and Mich were very similar they want to see you research but will also teach you everything about ortho and all the different treatment options.

I was at Houston and Baylor I really liked both these programs being from Florida I wouldn’t mind being in the south. I think that Baylor is a very strong program the staff and residents seemed very happy.

My rank list is:

1. Baylor

2. Mich

3. Ohio State

4. Houston

5. Louisville

6. UNC

7. NOVA my home school

I will not be ranking Washington Hospital Center, Pitt or Temple

I have declined an invite from Colorado

What do u mean by "weak clinically" ? Pitts residents seemed happy and like to have fun Yeh but that doesn't mean that they have a weak clinic.

 

[bentwires5]

I dont plan to rank programs that I would not be happy attending. I feel I will match.
For the Pitt weak clinical and diagnosing skills... I have heard from several residents that there is a lack of patients and two teachers left and started a school 43 miles away that has hurt the program in alot of ways.

 

[charlestweed]

No matter how poorly run the program is, you will still be an orthodontist. If you can teach yourself in dental school, you should have no problem teaching yourself in ortho residency. There are a ton of books you can read and CE classes you can attend. Since it is a paid program, Washington hospital would be the #1 on my list. You can use the money you earn to travel to different places to attend ortho CE classes (…and have fun) during your ortho residency.

I did zero impacted canine case at my ortho program. Now at my private practice, I see, on the average, 2 impacted cases per day. When I worked for the chains, I learned from the successes and failures of my predecessors and from my own mistakes. I also learned from my assistants who shared to me some of the cool techniques that other orthodontists used.

You should rank all the programs that invited you.

 

[lwen5]

No matter how poorly run the program is, you will still be an orthodontist. If you can teach yourself in dental school, you should have no problem teaching yourself in ortho residency. There are a ton of books you can read and CE classes you can attend. Since it is a paid program, Washington hospital would be the #1 on my list. You can use the money you earn to travel to different places to attend ortho CE classes (…and have fun) during your ortho residency.

I did zero impacted canine case at my ortho program. Now at my private practice, I see, on the average, 2 impacted cases per day. When I worked for the chains, I learned from the successes and failures of my predecessors and from my own mistakes. I also learned from my assistants who shared to me some of the cool techniques that other orthodontists used.

My dental school big brother got 8 interview invitations. He almost declined the 8th program (due to travel cost) but he decided to go at the very last minute. He ranked that program last. And he matched to that last program. You should rank all the programs that invited you.

Absolutely. Knowledge is nobody's property. It most certainly isn't the property of these corrupt, money laundering educational institutions. Who says you can't learn things on your own?

 

[rbmdmd]

Im paranoid that my matches wont go through or won't register with the schools....ive got it printed out for proof but it's a scary thought. Anybody know how it goes down and what time we find out on dec 4th? I guess i could look it up but thats no fun

 

[hopefullyortho]

We will find out at 11 59 am either by email or u can go to match website to find out.

 

[hopefullyortho]

Make sure after you submit Ur final ranking you certify it by clicking the certify button then it will ask u to enter Ur username and password again then u will receive an email saying Ur list is certified.

 

[bentwires5]

Sorry about all the controversy over my post. I was simply posting to just give a little insight for future applicants. I wanted to share my own personal opinion because I have a few people do that for me and it was probably the most helpful thing during the application process.

I have submitted my list and I feel confident with it. I dont want to match anywhere I dont want to go.

 

[gryffindor]

Sorry about all the controversy over my post. I was simply posting to just give a little insight for future applicants. I wanted to share my own personal opinion because I have a few people do that for me and it was probably the most helpful thing during the application process.

I have submitted my list and I feel confident with it. I dont want to match anywhere I dont want to go.

To anyone else reading this, leaving programs off your rank list is very bad advice. Nearly half the students who submit rank lists through match do not match. Ask yourself if you would rather be at the worst ortho program you interviewed with or be doing root canals on second molars next year? I would choose a paid program in Washington DC any day over the root canal. Rank all of your interviews!

 

[playa2652]

To anyone else reading this, leaving programs off your rank list is very bad advice. Nearly half the students who submit rank lists through match do not match. Ask yourself if you would rather be at the worst ortho program you interviewed with or be doing root canals on second molars next year? I would choose a paid program in Washington DC any day over the root canal. Rank all of your interviews!

I couldn't agree more gryffindor! I just got into Ortho this year, and I'm glad the RCT I'm doing on tooth #3 tomorrow will be one of the last root canals of my entire life!

 

[CMistry]

To anyone else reading this, leaving programs off your rank list is very bad advice. Nearly half the students who submit rank lists through match do not match. Ask yourself if you would rather be at the worst ortho program you interviewed with or be doing root canals on second molars next year? I would choose a paid program in Washington DC any day over the root canal. Rank all of your interviews!

Agreed 100%. All this talk of "good" and "bad" programs is nice, but in reality you will be an orthodontist no matter where you go and the job prospects will be the same. I (for OMFS) had 16 programs on my rank list and 1 place I really didn't want to go.. but I still ranked it #17. It never hurts to be humble.

 

[chuckd303]

Agreed 100%. All this talk of "good" and "bad" programs is nice, but in reality you will be an orthodontist no matter where you go and the job prospects will be the same. I (for OMFS) had 16 programs on my rank list and 1 place I really didn't want to go.. but I still ranked it #17. It never hurts to be humble.

Which program number did you match into?

 

[hopefullyortho]

To kill some time before the match day I am wondering what is the national average of student loans debt after ortho residency ? Hopefully If I get into one, my student loan debt after ortho residency including dental school will be around 290 k to 310 k (before the interests of course). is this around the average ? whats urs ?

 

[lwen5]

Hopefully If I get into one, my student loan debt after ortho residency including dental school will be around 290 k to 310 k (before the interests of course). is this around the average ? whats urs ?

 

[hopefullyortho]

is it too much ?!

 

[Dent010]

Ill be at 430 alone from dental and minimum if 530 after residency

 

[hopefullyortho]

177 k for dental school thanks for scholarships, and 125 k for ortho residency

 

[chuckd303]

To kill some time before the match day I am wondering what is the national average of student loans debt after ortho residency ? Hopefully If I get into one, my student loan debt after ortho residency including dental school will be around 290 k to 310 k (before the interests of course). is this around the average ? whats urs ?

Had 200k from dental school which fortunately has been paid down to 40k now. Depending on the program ortho could add 100k to 200k to that total.

 

[charlestweed]

For me, 150k for both DDS and ortho. And for my wife, 308k for both DDS and perio. The required minimum student loan repayment was around $5,500 a month. To force ourselves to pay off the student loans as fast as we could, we decided not to stretch the loan repayment to 30-year period. We paid off our student loans in 5 years. We could have paid them off sooner if we didn't spend our money on purchasing an existing perio practice and setting up my ortho office from scratch.

My wife had asked me to use her perio office to start my ortho business but I repeatedly declined for I thought that her office was too old and small. It didn't have any appeal for the young ortho patients. The office was in an very poor neighborhood and was surrounded by apartment complexes. Four years later, I finally accepted my wife's offer. I got nothing to lose since the rent was already paid for and I could use her staff. I spent about $20k for a pan/ceph machine and ortho instruments. In just one year, I started more than 100 cases. Thanks to the low overhead, I was able charge my patients low fees and got very high case acceptance rate. Realizing this perio/ortho office was too small, I decided to set up an ortho office from scratch and moved my patients there.

To survive with a huge amount of debt, I think you really need to keep the overhead as low as possible. Beside your own practice, you can gain additional income from getting a part time job. Due to the oversaturation (especially in SoCal), you shouldn't turn down the job offers that don't pay you a lot. Having a low paying job is better than staying at home. Having a job also allows you to improve your clinical skills. The more cases you treat, the more you will learn. Once your practice have enough patients , you can leave your associate job and set up a larger nicer office.

Two very nice ortho offices in my area had to close down due to high overhead and lack of patients. One was sold to a dental chain, PDS. The selling orthodontist now works for PDS. And the other office had to merge with another nearby ortho office.

 

[chuckd303]

what was your key to starting 100 new cases out of your wifes office? Was it just word of mouth about your reasonable fees? I have a gp practice now. would you recommend holding onto it during residency(by getting and associate to work it) and working it part time after I finish to help pay the bills. Being an orthodontist, would you have a tuition cost ceiling above which orthodontic residency is not worth the cost? I have a family member going into general dentistry and they are going to come away with 400k debt. At that cost I do not think I would have pursued dentistry. I feel like i have a good handle on what I can do as a GP by working several years but I have trouble determining if some of theses higher cost residencies are worth the added cost and debt. i enjoy reading your posts and find your perspective enlightening.

 

[Contach]

To anyone else reading this, leaving programs off your rank list is very bad advice. Nearly half the students who submit rank lists through match do not match. Ask yourself if you would rather be at the worst ortho program you interviewed with or be doing root canals on second molars next year? I would choose a paid program in Washington DC any day over the root canal. Rank all of your interviews!

Agreed! There are a lot of people who don't match every year, some of whom have a lot of interviews. Never be too confident, and you should prepare for the worst. There is a lot of unknown in the process - don't get ahead of yourself and remain humble.

The key to happiness is lowering your expectations.

 

[hopefullyortho]

To survive with a huge amount of debt, I think you really need to keep the overhead as low as possible. Beside your own practice, you can gain additional income from getting a part time job. Due to the oversaturation (especially in SoCal), you shouldn't turn down the job offers that don't pay you a lot. Having a low paying job is better than staying at home. Having a job also allows you to improve your clinical skills.

I totally agree

 

[charlestweed]

what was your key to starting 100 new cases out of your wifes office? Was it just word of mouth about your reasonable fees? I have a gp practice now. would you recommend holding onto it during residency(by getting and associate to work it) and working it part time after I finish to help pay the bills. Being an orthodontist, would you have a tuition cost ceiling above which orthodontic residency is not worth the cost? I have a family member going into general dentistry and they are going to come away with 400k debt. At that cost I do not think I would have pursued dentistry. I feel like i have a good handle on what I can do as a GP by working several years but I have trouble determining if some of theses higher cost residencies are worth the added cost and debt. i enjoy reading your posts and find your perspective enlightening.

I think it’s the combination of reasonable fee and good services. Instead of doing a lot of reties at the beginning of the tx, I tried to impress my new patients and gained their trust by making positive changes on their teeth as fast as I could….such as closing a midline diastema even before the dental arch was completely leveled, retracting the 3s as soon as the 4s were extracted, using the closing loops to retract the flare upper incisors etc. In my opinion, these quick improvements on their teeth impress the patients a lot more than what the high tech gadgets can. And these happy patients went around telling their friends and relatives how wonderful their teeth looked after just a few months of ortho tx.
When I first started, I also went from door to door to meet all of my wife’s existing referring GPs and to let them know that we added ortho specialty to our office.

Do you like the location of your GP office? Do you like the current rent rate? Is the landlord a reasonable person? Do you think the associate GP can help you generate enough income to pay for the office’s overhead? If the answers are yes, then I think you should hold to it until you finish your ortho residency. Once you graduate, you can convert this office into an ortho office. You can refer all of your existing GP patients to the local GP offices for continuation of care. Hopefully these GPs will refer the ortho patients to your office.

 

[Twang77]

Thank you charlstweed for all the great info. Just out of curiosity, are you a pure tweed guy? Zero prescription brackets?

As for the debt question, I am lucky in that I won't have any. Obviously nothing is certain but my hope is to stay in state where my school costs around 1k a year.

 

[charlestweed]

Thank you charlstweed for all the great info. Just out of curiosity, are you a pure tweed guy? Zero prescription brackets?

As for the debt question, I am lucky in that I won't have any. Obviously nothing is certain but my hope is to stay in state where my school costs around 1k a year.

No, I currently use .022 Roth prescription brackets. I extract a lot. I like to finish my cases with the lower incisors are at right angle with the mandibular plane. I treat a high percentage of Hispanic and Asian patients. Lip incompetence and bimax protrusive incisors are the common chief complaints.

Twang77, thanks for reading my posts and good luck with the match.

 

[Silent Cool]

For me, 150k for both DDS and ortho. And for my wife, 308k for both DDS and perio. The required minimum student loan repayment was around $5,500 a month. To force ourselves to pay off the student loans as fast as we could, we decided not to stretch the loan repayment to 30-year period. We paid off our student loans in 5 years. We could have paid them off sooner if we didn't spend our money on purchasing an existing perio practice and setting up my ortho office from scratch.

My wife had asked me to use her perio office to start my ortho business but I repeatedly declined for I thought that her office was too old and small. It didn't have any appeal for the young ortho patients. The office was in an very poor neighborhood and was surrounded by apartment complexes. Four years later, I finally accepted my wife's offer. I got nothing to lose since the rent was already paid for and I could use her staff. I spent about $20k for a pan/ceph machine and ortho instruments. In just one year, I started more than 100 cases. Thanks to the low overhead, I was able charge my patients low fees and got very high case acceptance rate. Realizing this perio/ortho office was too small, I decided to set up an ortho office from scratch and moved my patients there.

To survive with a huge amount of debt, I think you really need to keep the overhead as low as possible. Beside your own practice, you can gain additional income from getting a part time job. Due to the oversaturation (especially in SoCal), you shouldn't turn down the job offers that don't pay you a lot. Having a low paying job is better than staying at home. Having a job also allows you to improve your clinical skills. The more cases you treat, the more you will learn. Once your practice have enough patients , you can leave your associate job and set up a larger nicer office.

Two very nice ortho offices in my area had to close down due to high overhead and lack of patients. One was sold to a dental chain, PDS. The selling orthodontist now works for PDS. And the other office had to merge with another nearby ortho office.

CT,
If you and your wife each owed 500K (or a million total), how long would you guess it would have taken you to pay it all off?
thanx

 

[charlestweed]

CT,
If you and your wife each owed 500K (or a million total), how long would you guess it would have taken you to pay it all off?
thanx

It would probably still take us 5 years to pay them off. If we owed 1 million in student loans, we would have chosen NOT to have the kind of lifestyle that we currently have right now. There would be no vacations 2-3 times a year. We would not have leased brand new German cars every 3 years. We wouldn’t have bought nice houses, rental properties, and fancy Ethan Allen furniture etc if we had such massive debt. We would have driven a cheap and reliable Toyota Camry, lived in an apartment, and tried to pay off our student loans as fast as we could.


I know it is not fair for me to say that “if I can make it in this very saturated market in CA, so can any of you.” Unlike me, you guys have to pay a lot more for your education. And the associate jobs for new grad orthodontists were much more abundant in the early 2000s. There was actually a shortage of orthodontists in CA because of the difficulty in obtaining a CA dental license. Blaming the government for causing the rise in college tuition will not make problem go away. It is our fault that we have accumulated so much debt for our children/grandchildren to pay back in the future. To fix such mistake, I just have to continue to work as hard as I can to save enough for my kids so they won’t have to borrow any student loan when they enter college.


I hope many of you here will match to the less expensive ortho program of your choice.

 

[ortho lurker]

It would probably still take us 5 years to pay them off. If we owed 1 million in student loans, we would have chosen NOT to have the kind of lifestyle that we currently have right now. There would be no vacations 2-3 times a year. We would not have leased brand new German cars every 3 years. We wouldn’t have bought nice houses, rental properties, and fancy Ethan Allen furniture etc if we had such massive debt. We would have driven a cheap and reliable Toyota Camry, lived in an apartment, and tried to pay off our student loans as fast as we could.


I know it is not fair for me to say that “if I can make it in this very saturated market in CA, so can any of you.” Unlike me, you guys have to pay a lot more for your education. And the associate jobs for new grad orthodontists were much more abundant in the early 2000s. There was actually a shortage of orthodontists in CA because of the difficulty in obtaining a CA dental license. Blaming the government for causing the rise in college tuition will not make problem go away. It is our fault that we have accumulated so much debt for our children/grandchildren to pay back in the future. To fix such mistake, I just have to continue to work as hard as I can to save enough for my kids so they won’t have to borrow any student loan when they enter college.


I hope many of you here will match to the less expensive ortho program of your choice.

Economy was much better back then also.

 

[TheGreenWave]

To kill some time before the match day I am wondering what is the national average of student loans debt after ortho residency ? Hopefully If I get into one, my student loan debt after ortho residency including dental school will be around 290 k to 310 k (before the interests of course). is this around the average ? whats urs ?

After factoring in three years of additional interest on my pre-residency loans & new loans for living expenses during my residency, I will enter the real world with a touch under $400k in debt. Let that sink in... If I think about how much I owe for too long, Ill have to change my pants.

Honestly, I cannot imagine how someone who took out loans to fund all of their education (read: parents did not help) could end up with much less than this... Granted, I went to a private undergrad, but had nearly a full-ride with scholarships. I went to a very affordable dental school and had some small scholarships there too. And I matched to an ortho residency which doesn't charge tuition. Unless you follow in Walter White's footsteps, someone who takes out loans to fund their education will inevitably incur 300-400k in loans to become an orthodontist. If you went to private schools this number could easily double. Insane.

 

[Silent Cool]

After factoring in three years of additional interest on my pre-residency loans & new loans for living expenses during my residency, I will enter the real world with a touch under $400k in debt. Let that sink in... If I think about how much I owe for too long, Ill have to change my pants.

Honestly, I cannot imagine how someone who took out loans to fund all of their education (read: parents did not help) could end up with much less than this... Granted, I went to a private undergrad, but had nearly a full-ride with scholarships. I went to a very affordable dental school and had some small scholarships there too. And I matched to an ortho residency which doesn't charge tuition. Unless you follow in Walter White's footsteps, someone who takes out loans to fund their education will inevitably incur 300-400k in loans to become an orthodontist. If you went to private schools this number could easily double. Insane.

Green, based on your current understanding of the market, how long do you suppose it would take one to pay off 500K? Have you established ties/connections with any practices out there in preparation for your first post-grad job? What are the offers like?

thanx

 

[rbmdmd]

500k for school loans is one thing and if you buy into a practice you take on even more....i would pay off 10% a year on that loan if you arent buying into a business

 

[Twang77]

Welp, only one more week!

 

[TheGreenWave]

Green, based on your current understanding of the market, how long do you suppose it would take one to pay off 500K? Have you established ties/connections with any practices out there in preparation for your first post-grad job? What are the offers like?

thanx

This is pretty difficult to answer and would be highly variable from person to person. First, I should say that I don't have a great understanding of the current market nor the climate for new grads finding jobs in ortho. I have no connections currently, though I'd like to believe I have a nice network in Houston. How much you make as an orthodontist depends on many variables. From what I hear your first few years you can make anywhere from $150k on the lower end to $300k on the higher end. If you associate, you will start on the low end and if you buy a thriving practice you can start on the higher end.

The options are more or less:
1. Associate. But not that many orthodontists have enough patients to make this work unless they have several satellites.
2. Sell your soul and go corporate. Keep in mind these jobs aren't as readily available as before.
3. Start from scratch. This will probably require approximately $400k in loans and supplementary income by working elsewhere while your practice grows.
4. Work for a pediatric dentist. Some orthodontists feel strongly about not doing this but I won't go in to that.
5. Buy a practice. This will require something closer to $1,000,000 in loans. And it's currently very hard to find ortho practices for sale... Orthodontists don't retire, they just die.

So, how fast I'll be able to pay it back will depend on what kind of job I can find and how much I'll take home. Since I'm still 2.5 yrs away I'm not currently searching for jobs. I have already decided I am going to do everything in my power to pay them in 10 years. That means some serious sacrifices. I'll have to live like a student for a few more years: cook all my own meals, drive a very affordable car, doing all my own ironing, not taking luxurious trips, etc.. Also, I will not (intentionally) start a family until my finances are in order. I'm also going to attack my high interest loans first and pay the lower interest ones more slowly.

It's going to suck but I won't be able to chill until my loans are under control. The faster I can get the debts paid off the sooner I can reap the benefits of this awesome profession.

 

[Silent Cool]

For me, 150k for both DDS and ortho. And for my wife, 308k for both DDS and perio. The required minimum student loan repayment was around $5,500 a month. To force ourselves to pay off the student loans as fast as we could, we decided not to stretch the loan repayment to 30-year period. We paid off our student loans in 5 years. We could have paid them off sooner if we didn't spend our money on purchasing an existing perio practice and setting up my ortho office from scratch.

My wife had asked me to use her perio office to start my ortho business but I repeatedly declined for I thought that her office was too old and small. It didn't have any appeal for the young ortho patients. The office was in an very poor neighborhood and was surrounded by apartment complexes. Four years later, I finally accepted my wife's offer. I got nothing to lose since the rent was already paid for and I could use her staff. I spent about $20k for a pan/ceph machine and ortho instruments. In just one year, I started more than 100 cases. Thanks to the low overhead, I was able charge my patients low fees and got very high case acceptance rate. Realizing this perio/ortho office was too small, I decided to set up an ortho office from scratch and moved my patients there.

To survive with a huge amount of debt, I think you really need to keep the overhead as low as possible. Beside your own practice, you can gain additional income from getting a part time job. Due to the oversaturation (especially in SoCal), you shouldn't turn down the job offers that don't pay you a lot. Having a low paying job is better than staying at home. Having a job also allows you to improve your clinical skills. The more cases you treat, the more you will learn. Once your practice have enough patients , you can leave your associate job and set up a larger nicer office.

Two very nice ortho offices in my area had to close down due to high overhead and lack of patients. One was sold to a dental chain, PDS. The selling orthodontist now works for PDS. And the other office had to merge with another nearby ortho office.

CT,
What kind of daily rates is PDS offering for an orthodontist?

 

[charlestweed]

Economy was much better back then also.

Yeah, I really miss the good old days. Before 2006, I made about half as much as what I make today because I worked full time as an associate and didn’t own a practice. And yet, I feel like I was able to save more money in the past than what I can today. Everything was so much cheaper. I really miss $2.5/gallon gas price. The cell phone plan was under $50/month because there was no such thing as 4g LTE smartphone plan. My first house (2700sf, 4bed, 3 bath) only cost $382k. With just $38k (or 10 % down), I became a proud homeowner only 3 months after I finished my ortho residency. Now, this same house probably costs more than $700k even with the recent housing bubble.

 

[charlestweed]

CT,
What kind of daily rates is PDS offering for an orthodontist?

I don’t know because I never work for PDS. The salary is probably similar to what the other chains pay their associate orthodontists. I believe Ortho Lurker already mentioned these salary figures on the other threads.

 

[charlestweed]

3. Start from scratch. This will probably require approximately $400k in loans and supplementary income by working elsewhere while your practice grows.

Or you can have a simple office for under $100k. I spent $35k to convert an OBGYN office to an ortho office. Since it was already an existing medical office, I didn’t need to waste time waiting for the city to approve the construction project. It only took a month to complete the conversion project. The patients don’t really care what you have in your office. I can still wow them with my $10k non-digital pan/ceph machine. As long as you make your patients’ teeth straight after 2 years, they are happy. No matter how beautiful your office looks, no matter how long you spend time to communicate with your patients, they will still be mad at you if you fail to finish the case on time. Your clinical skills, your honesty, your friendly personality are what your patient will look at.


At the dental chain where I currently work at, many of my patients have complained to me about the poor customer service at the front. When I hear these complains, I quickly offer my apology to them and they really appreciate that. They tell me that I am the reason why they keep referring their friends and relatives to the office.

5. Buy a practice. This will require something closer to $1,000,000 in loans. And it's currently very hard to find ortho practices for sale... Orthodontists don't retire, they just die.

What? One million dollars for a practice? The reason the dentists sell their practice is their practices are on a downward trend. If the office continues to make good money, why would the orthodontist want to sell it? In 2006, I made a full price offer to buy an existing practice for $500k but the seller rejected my offer and sold it to another ortho. I am glad he declined my offer. I later found out that the buyer of this office had to close it down and merged with another ortho practice.


In 2009, I purchased an existing office from a 60 yo orthodontist. I recognized that it was a dying practice but I still paid $165k for it. I treated this dying practice as if it was a practice that I set up from scratch. There were a lot of things I could do to bring down the overhead and to maximize the profit. As soon as I took over the ownership, I cancelled the useless yellow page ad subscription. I fired all the slow existing RDAs and replaced them with the faster ones. I demoted the existing office manager to receptionist position. I reduced the clinic days from 16 days/month down to just 6 days/month so I only need to hire part time employees.

 

[TheGreenWave]

Tweed, I think its wonderful that you were able to start a practice for so little. Your practice model seems to be very thrifty and pt-centered. However, I respectfully disagree that people don't care what your office looks like. If your practice sees a high percentage of Medicare/Medicaid patients, I can see how a low-budget office may not be a turn off. On the other hand, if you are geared to a slightly more affluent population, as I would imagine most orthodontists would be, having a reasonably nice office is a must. Though I believe solid clinical skills, good patient rapport, and a friendly staff are all more important to your success, a cheap office might be a deal breaker for many patients. But what do I know? I'm just a first year resident and you're seasoned orthodontist.

As far as the cost of buying a practice, I was referring to a thriving, not dying, practice. In talking with orthodontists and residents who are looking to buy, the cost can easily approach a million. Why would an orthodontist sell high? I can think of two reasons: so they get the most money out of their nest egg & to retire somewhere awesome. I don't know how or where you found a practice for $165k, but good for you. If you don't mind me asking, how many starts did they have the year prior to your purchase? How much it will cost you to buy a practice is kind of a moot point when you consider the relative scarcity of orthodontic practices for sale. I have no hard (or even soft) data, but through the grapevine I've heard many orthodontists are holding off the sale of their practice until the economy bounces back.

 

[charlestweed]

Tweed, I think its wonderful that you were able to start a practice for so little. Your practice model seems to be very thrifty and pt-centered. However, I respectfully disagree that people don't care what your office looks like. If your practice sees a high percentage of Medicare/Medicaid patients, I can see how a low-budget office may not be a turn off. On the other hand, if you are geared to a slightly more affluent population, as I would imagine most orthodontists would be, having a reasonably nice office is a must. Though I believe solid clinical skills, good patient rapport, and a friendly staff are all more important to your success, a cheap office might be a deal breaker for many patients. But what do I know? I'm just a first year resident and you're seasoned orthodontist.

You are not the only person who disagrees with me. I know a few orthodontists, who tried my approach (low fee, low overhead) and didn't like it. They later had to raise their fees. I didn't invent this "low fee, low overhead" business strategy. I learned from the successful orthodontists, who started their practices before me. The main point of my posts is with the enormous amount of student loan debt, a new grad should be more careful about borrowing additional large loan for setting up a new practice. I had the luxury of spending $400k if I wanted to because my student loan debt was a fraction of what you owe. And yet, I was still very careful about spending my money when I started my first practice. Some like to spend $400k for a new practice and live like a student for a couple of years while the practice is growing. But for me, I'd rather have a small simple practice and have a kind of lifestyle that an orthodontist is supposed to have.

My practices don't only see low income patients. There is a high percentage of Asian patients at my practices and their parents are engineers and doctors. I also treat a lot of sons and daughters of my referring GPs. Why only attract the top 20% income earners? Why not welcome everybody to the practice?

I am glad that I went to a program that taught me how to do good ortho without the high tech gadgets. I am glad that my director made us fabricate all the ortho appliances by ourselves. When I got out, working at a busy low tech chain clinic was an easy transition. When I had my practice, I purchased the same cheap pan/ceph unit that my ortho program used. I trained my staff to make ortho appliances and have save a lot of money.

As far as the cost of buying a practice, I was referring to a thriving, not dying, practice. In talking with orthodontists and residents who are looking to buy, the cost can easily approach a million. Why would an orthodontist sell high? I can think of two reasons: so they get the most money out of their nest egg & to retire somewhere awesome. I don't know how or where you found a practice for $165k, but good for you. If you don't mind me asking, how many starts did they have the year prior to your purchase? How much it will cost you to buy a practice is kind of a moot point when you consider the relative scarcity of orthodontic practices for sale. I have no hard (or even soft) data, but through the grapevine I've heard many orthodontists are holding off the sale of their practice until the economy bounces back.

If I were a 60 year old ortho and had a thriving practice, I wouldn't sell it. I would just hire a new grad ortho and use his/her youth and good look to help increase the office production.

$165k was actually too much for such dying practice. A lot of people came and looked at it but no one made an offer. The practice was 30 years old and only had 140 active patients. Only one GP refers patients to this practice. I bought it because I figured it would cost me about the same if I had to start one from scratch. So I got nothing to lose. And I was right. Unlike setting it up from scratch, this existing practice gave me positive income right on day one. The office saw mostly White patients. None of the existing staff spoke Spanish. When I took over, I brought in 3 Spanish speaking assistants. Now, this office has a good mixture of White, Hispanic, and Asian patients. Last year, I replaced all the old chairs with the new ones and put in the new tiles to make it look more modern. The entire renovation project cost me under $20k.

 

[Silent Cool]

You are not the only person who disagrees with me. I know a few orthodontists, who tried my approach (low fee, low overhead) and didn't like it. They later had to raise their fees. I didn't invent this "low fee, low overhead" business strategy. I learned from the successful orthodontists, who started their practices before me. The main point of my posts is with the enormous amount of student loan debt, a new grad should be more careful about borrowing additional large loan for setting up a new practice. I had the luxury of spending $400k if I wanted to because my student loan debt was a fraction of what you owe. And yet, I was still very careful about spending my money when I started my first practice. Some like to spend $400k for a new practice and live like a student for a couple of years while the practice is growing. But for me, I'd rather have a small simple practice and have a kind of lifestyle that an orthodontist is supposed to have.

My practices don't only see low income patients. There is a high percentage of Asian patients at my practices and their parents are engineers and doctors. I also treat a lot of sons and daughters of my referring GPs. Why only attract the top 20% income earners? Why not welcome everybody to the practice?

I am glad that I went to a program that taught me how to do good ortho without the high tech gadgets. I am glad that my director made us fabricate all the ortho appliances by ourselves. When I got out, working at a busy low tech chain clinic was an easy transition. When I had my practice, I purchased the same cheap pan/ceph unit that my ortho program used. I trained my staff to make ortho appliances and have save a lot of money.

If I were a 60 year old ortho and had a thriving practice, I wouldn't sell it. I would just hire a new grad ortho and use his/her youth and good look to help increase the office production.

$165k was actually too much for such dying practice. A lot of people came and looked at it but no one made an offer. The practice was 30 years old and only had 140 active patients. Only one GP refers patients to this practice. I bought it because I figured it would cost me about the same if I had to start one from scratch. So I got nothing to lose. And I was right. Unlike setting it up from scratch, this existing practice gave me positive income right on day one. The office saw mostly White patients. None of the existing staff spoke Spanish. When I took over, I brought in 3 Spanish speaking assistants. Now, this office has a good mixture of White, Hispanic, and Asian patients. Last year, I replaced all the old chairs with the new ones and put in the new tiles to make it look more modern. The entire renovation project cost me under $20k.

What take-home is that?
Do you max out a SEP IRA every year? A Traditional IRA?
What are the gross receipts and overhead?

thanx

 

[gn4]

CT, if you don't mind me asking, what ortho residency program did you attend? UCLA? Also, do you work at a chain and have your own practice? you work at two places? Does an orthodontist need to work in multiple places to stay busy? Also, how many active patients is one supposed to have for an ortho office? I just now got accepted to dental school, so I'm pretty green and know nothing. Forgive me if I'm asking dumb questions.

 

[eliwoohoo]

CT, if you don't mind me asking, what ortho residency program did you attend? UCLA? Also, do you work at a chain and have your own practice? you work at two places? Does an orthodontist need to work in multiple places to stay busy? Also, how many active patients is one supposed to have for an ortho office? I just now got accepted to dental school, so I'm pretty green and know nothing. Forgive me if I'm asking dumb questions.

I believe charlestweed did his residency at Louisville. He owns his own practice and works a few days a month at a chain.

Not a practicing orthodontist, but learned quite a lot about the specialty while deciding to apply to the residency. There is no magic number of satellite offices or pts that an orthodontist must see, it depends on competition, overhead, orthodontist's desired workload etc. Many orthodontists who want a full schedule own or work in satellite offices in saturated locations like Southern California. An orthodonists can see 100 pts/day (and can be pushed to do so when employed by dental chains), but for quality of care, many feel that ~50 pts/day is achievable and comfortable.

Again, not a practicing orthodontist, but just what I've gleaned from ortho residents and private practitioners.

 

[gryffindor]

Tweed, I think its wonderful that you were able to start a practice for so little. Your practice model seems to be very thrifty and pt-centered. However, I respectfully disagree that people don't care what your office looks like. If your practice sees a high percentage of Medicare/Medicaid patients, I can see how a low-budget office may not be a turn off. On the other hand, if you are geared to a slightly more affluent population, as I would imagine most orthodontists would be, having a reasonably nice office is a must. Though I believe solid clinical skills, good patient rapport, and a friendly staff are all more important to your success, a cheap office might be a deal breaker for many patients. But what do I know? I'm just a first year resident and you're seasoned orthodontist.

As far as the cost of buying a practice, I was referring to a thriving, not dying, practice. In talking with orthodontists and residents who are looking to buy, the cost can easily approach a million. Why would an orthodontist sell high? I can think of two reasons: so they get the most money out of their nest egg & to retire somewhere awesome. I don't know how or where you found a practice for $165k, but good for you. If you don't mind me asking, how many starts did they have the year prior to your purchase? How much it will cost you to buy a practice is kind of a moot point when you consider the relative scarcity of orthodontic practices for sale. I have no hard (or even soft) data, but through the grapevine I've heard many orthodontists are holding off the sale of their practice until the economy bounces back.

I learned to "slap on braces" (from your other thread) not too far from you. While I was in residency, I too thought that a gleaming beautiful office designed by an interior decorator was basically a given in an ortho office. Seemed like the "Taj Mahal" offices were the only thing people were building out that way. I got out and moved to a more densely populated area of the country and learned that there are many ortho office models - the Taj Mahals, the charlestweed offices, the chains, etc. You can get good ortho or poor ortho out of any of them. It truly depends on the doctor and the customer service. Not on the iPad bar and Rewards Hub.

 

[charlestweed]

What take-home is that?
Do you max out a SEP IRA every year? A Traditional IRA?
What are the gross receipts and overhead?

thanx

How much take home? Well, it depends on where you live, how much you owe in student loans, and your spending habit. Dentistry/orthodontics won’t make you rich....unless you do shady things and over-treatment plan every case. In order to retire early and comfortably, you will need to invest your money wisely. The rental properties that I am investing in right now will serve as my retirement income. I can’t practice orthodontics forever. A major car accident or a deadly cancer can easily take away my income and put the burdens on my wife and kids. I have both disability and life insurances but they are not enough.


I’ve contributed very little to my 401k because I need the money to pay off student/business/home loans, set up 3 offices, invest in rental properties etc. I’ve only been out of school a little over 10 years ago. I didn’t save anything during the first 5 years because I tried to pay off loans.


The average overhead for all 3 offices is around $24k a month (or $8/month for each office). When I started my first office, the monthly overhead was under $2k a month because I used my wife’s office space, office manager, and chair side assistant. It is almost impossible to fail when you have such low overhead.

 

[charlestweed]

I believe charlestweed did his residency at Louisville. He owns his own practice and works a few days a month at a chain.

Not a practicing orthodontist, but learned quite a lot about the specialty while deciding to apply to the residency. There is no magic number of satellite offices or pts that an orthodontist must see, it depends on competition, overhead, orthodontist's desired workload etc. Many orthodontists who want a full schedule own or work in satellite offices in saturated locations like Southern California. An orthodonists can see 100 pts/day (and can be pushed to do so when employed by dental chains), but for quality of care, many feel that ~50 pts/day is achievable and comfortable.

Again, not a practicing orthodontist, but just what I've gleaned from ortho residents and private practitioners.

Thanks for answering Gn4’s questions and I agree with everything you said above.

 

[Twang77]

How difficult is it to start an ortho practice straight out of residency? It seems daunting going into a town that already has its referrals set up. Anyone able to shed light on this?

 

[ortho lurker]

How difficult is it to start an ortho practice straight out of residency? It seems daunting going into a town that already has its referrals set up. Anyone able to shed light on this?

Very difficult to set up your stand-alone, ortho-only practice. The trend is partnering with a GP to set up a group practice, or to rent space out of other GP or specialist's offices and travel.