Pay over $350k for ortho residency?

[JacquesVallee]

I think we can all agree the state of the dental profession is in serious decline…

Big Hoss

100%. When predents have shadowed at my office I've always tried to steer all of them away from dentistry. Sadly, none of them listen. There is still this crazy misconception that all dentists are super wealthy which couldn't be further from the truth, especially for new grads.

Also, even though I went to a "cheap" state school, most of my classmates aren't even paying off their loans. Rather, they're relying on government loan forgiveness programs. The current state of dentistry is even attending some of the cheapest dental schools will still require you to go on IBR or PAYE. This isn't sustainable for an entire profession.

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[yappy]

Except omfs.

Doesn’t it have the same issues? Massive debt? Wouldn't you rather be an oms that graduated 20 years ago vs today? All the ones I know work for DSOs or their specialty’s variant.

 

[charlestweed]

I graduated during the “golden age” era (in 2001) when the average daily pay for associate orthodontists was around $800-1000/day. I worked for 3 different Corp offices. I had to see around 80-100 patients a day with only 3 ortho RDAs. I had to work as an extra RDA (doing wire changing and sterilizing instruments myself) in order to keep up with the busy schedule. I also opened my own office. When I finished work the corp offices at 6pm, I drove straight to my office to see my patients until 9pm…..my wife worked at front desk…..and my 2 yo daughter slept inside one of the consultation rooms. With a positive cash flow (from my associate jobs), running a practice, which I set up from scratch, wasn’t too stressful.

Now that the golden age is over, the number of new start cases per day has declined a lot. I only see around 50-60 patients a day at this same corp office, where I’ve worked for for 20+ years (since graduation). 50-60 patients/day is a very easy day for a veteran orthodontist like me. And the company pays me more than 2X as much now than when I was first hired. They underpaid/overworked me in the past and I didn’t realize it. As a young grad with debt, I was desperate.

With years of experience and having zero debt, the job is so easy now.

 

[Big Time Hoosier]

Now that the golden age is over

Big Hoss

 

[White_Sponge_Nevus]

Every job in dentistry, regardless of specialty, isn't as good as it was a generation ago. If you're already in dental school, do what you'd be happiest doing so long that it's feasible with the debt:income situation you'll find yourself in.

If you're not in dental school yet, try to be wary of comparing your future career to that of anyone in dentist who is over the age of 40. It is a different career for them. They faced separate challenges but not the financial ones today. Dentistry is a terrible gig compared to dentistry of the previous generation but a much better gig than most available to us now. Gotta compare it to the right things.

 

[2TH MVR]

I think we can all agree the state of the dental profession is in serious decline…

Big Hoss

I would say the business side of dentistry has changed for the worse. Mostly due to Corporates turning dentistry into a profit only business.

Most of us were attracted to dentistry (I was anyway) for the chance to start a small business, treat patients ethically, and earn a good living for all the years we toiled in school.

Fortunately .... I love the practice of orthodontics. But I get it. Easier for someone in my position (close to retirement) as compared to those young dentists, specialists justing graduating, or just a few years in the profession.

 

[Greyangel6]

I use handpieces multiple times per day. Some days it feels like all I do is go from chair to chair using handpiece. Broken brackets, removing aligner attachments, removing bands/banded appliances, removing composite after braces coming off, repairing fixed retainers, etc etc. I will often also do enameloplasty to flatten out chipped incisors, or sometimes even add small amounts of composite to teeth to make a nicer looking incisal edge. All of these things require use of a handpiece. There's some misconception out there about ortho being easy on the body. My counter is this- have you ever seen an orthodontist in their late 60s or even 70s that's still practicing? Same hunched over back that all dentists get. I knew an older orthodontist who had multiple fused discs, and couldn't move his neck anymore. He had to move his whole torso.

Owning a practice is like two jobs. One job where you show up and do your work (not easy), then another job where you have to run the clinic and figure out how to get new patients in the door. This true for anyone who runs a practice. The lifestyle is great, you get to choose which 80 hours of the week you get to work!

I'm sure they mean it figuratively because I think I would rather do what you do now with the handpiece than working on tooth #2-DB on a patient with large cheek and constantly wanting to suction.

 

[702]

Every job in dentistry, regardless of specialty, isn't as good as it was a generation ago. If you're already in dental school, do what you'd be happiest doing so long that it's feasible with the debt:income situation you'll find yourself in.

If you're not in dental school yet, try to be wary of comparing your future career to that of anyone in dentist who is over the age of 40. It is a different career for them. They faced separate challenges but not the financial ones today. Dentistry is a terrible gig compared to dentistry of the previous generation but a much better gig than most available to us now. Gotta compare it to the right things.

maybe I’m blind, but I actually think omfs is not worse than it was decades ago. Maybe even better.

More full scope surgeries in office instead of in the OR, safer anesthesia practices, better implant dentistry in general, etc. The key is to have control of supply and demand of doctors id say, which omfs has done better than probably anyone else in all dentistry

 

[White_Sponge_Nevus]

maybe I’m blind, but I actually think omfs is not worse than it was decades ago. Maybe even better.

More full scope surgeries in office instead of in the OR, safer anesthesia practices, better implant dentistry in general, etc. The key is to have control of supply and demand of doctors id say, which omfs has done better than probably anyone else in all dentistry

You may be right... I was thinking more in the terms of purchasing power in every day life as well as an OMFS practice with current cost of living: income, as well as increased debt. But I do keep hearing of incredible jobs out there in areas that aren't overrun with current OMFS, and know a lot of retirements are on the horizon that will keep opportunities good for the people coming out over the next 10 years

 

[JacquesVallee]

What I love about OMFS is they don't drastically increase the number of residency spots and make pay to play programs like virtually every other dental specialty has done. They do a good job at keeping the barrier to entry very high, especially with keeping the CBSE. Ortho used to be the dream, but now programs like the Georgia school of Orthodontics take forty residents per class. I know OMFS around me who clear 7 figures while many of the younger Orthos around me have trouble staying busy or even finding full time work.

 

[New_Vegas]

What I love about OMFS is they don't drastically increase the number of residency spots and make pay to play programs like virtually every other dental specialty has done. They do a good job at keeping the barrier to entry very high, especially with keeping the CBSE. Ortho used to be the dream, but now programs like the Georgia school of Orthodontics take forty residents per class. I know OMFS around me who clear 7 figures while many of the younger Orthos around me have trouble staying busy or even finding full time work.

This is very true. If I could do it again I would not go into ortho.

 

[JacquesVallee]

This is very true. If I could do it again I would not go into ortho.

What would you do if you could go back?

 

[New_Vegas]

What would you do if you could go back?

Pediatric dentistry or oral surgery. Probably oral surgery. I had the grades to do it but chose chose ortho instead and I kick myself every day for it. Problem is, I had already chosen ortho before dental school and I didn't know then what I know now. I didn't even know I would like doing extractions until third year of dental school.

 

[OncePreDent]

Pediatric dentistry or oral surgery. Probably oral surgery. I had the grades to do it but chose chose ortho instead and I kick myself every day for it. Problem is, I had already chosen ortho before dental school and I didn't know then what I know now. I didn't even know I would like doing extractions until third year of dental school.

have you ever thought about going back for OMFS?

 

[charlestweed]

Pediatric dentistry or oral surgery. Probably oral surgery. I had the grades to do it but chose chose ortho instead and I kick myself every day for it. Problem is, I had already chosen ortho before dental school and I didn't know then what I know now. I didn't even know I would like doing extractions until third year of dental school.

How about quitting ortho and going back to practicing general dentistry? I know a general dentist who works at the same Corp with me who travels to multiple offices.....and he only does pedo.

 

[JacquesVallee]

Pediatric dentistry or oral surgery. Probably oral surgery. I had the grades to do it but chose chose ortho instead and I kick myself every day for it. Problem is, I had already chosen ortho before dental school and I didn't know then what I know now. I didn't even know I would like doing extractions until third year of dental school.

Yeah I understand where you're coming from. Hopefully, you don't have too much in loans and can just try to make the most out of Ortho.
I'd also recommend endo as a specialty to any dental student reading this as well.

 

[2TH MVR]

Yeah. The current cost of entry. Multiple ortho programs. Corps and everyone else doing ortho. Aligners. All of this has made a once enviable, proud specialty ... less so nowadays.

However. Saw our OMFS working on a crazy patient at the Corp office I work at. OMFS warned me that her patient was going to be "loud". And she was. Crying, screaming, emotional. My cortisol levels were climbing just hearing this patient. OMFS was doing a good job, but the patient was just being difficult. She was scheduled for sedation, but the patient ate breakfast prior to the procedure ... which meant no sedation according to the OMFS.

Anyway. Happy as hell doing ortho. Financially may not be close to OMFS, but I don't care. Life is more than money. Day to day experiences, memories are important in the long run.

 

[charlestweed]

Anyway. Happy as hell doing ortho. Financially may not be close to OMFS, but I don't care. Life is more than money. Day to day experiences, memories are important in the long run.

The income depends on how hard one works (traveling to more offices = more work days = more money) and the number of patients that one treats in a day. An orthodontist can see 70-80 patients a day, which is 10X more than the number of patients that an OS can typically see. Therefore, a no show or cancellation doesn’t hurt the orthodontist’s daily production that much. If a patient in an OS office doesn’t show up or has to reschedule (due to medical problems like having high blood pressure or forgetting to discontinue the blood thinner med), it will be a bigger drop in the production.

Most people (as high as 85% according to the Gallup poll) are unhappy with their jobs. They hate their jobs because they have to deal with the same cons every day....cons that people from other professions don't have to deal with. Dentistry/Ortho/OS/ENDO is just a job and working is not supposed to be fun. It’s part of human nature to wonder if there is something better out there…..AKA “the grass is greener” syndrome.

 

[Big Time Hoosier]

Dentistry/Ortho/OS/ENDO is just a job and working is not supposed to be fun.

Unless you’re a predent. Then it’s your “passion.”

Big Hoss

 

[charlestweed]

Unless you’re a predent. Then it’s your “passion.”

Big Hoss

It took me 3 days (4 hours per day) to clear the massively overgrown weeds at one of my rental properties. The tenants have just moved out. Since I had all the necessary equipment, I thought it would be a simple task. Man, it’s tough. I couldn’t do it for more than 4 hours per day because of the extreme heat from being exposed continuously to the hot Sun (and we’re still in the cool Spring Season). I got blisters on my hands despite wearing thick gloves. I am glad that I am a dentist. I feel bad for the people, especially the ones who are in their 50s, who have to do this backbreaking job every single day. When you guys have kids, never tell them to pursue a trade job even if it pays $100k+/yr. Save money and help pay for their college education.

 

[JacquesVallee]

never tell them to pursue a trade job even if it pays $100k+/yr.

It's terrible on your body. Being a GD in rural America, so many of my patients are in the trades and their knees and back are destroyed. One of my patients left the trades in his mid 30s for this reason.

 

[New_Vegas]

Are you guys going to sit here and pretend like dentistry isn't hard on the body? I've got family member who is a multimillionaire as an electrician, he's in great physical shape in his 60s. He looks better than most dentists in their 60s. No hunched over back, and neck. He's probably made more money and had less physical ailments than the vast majority of dentists.
At the end of the day it really depends on who you are as an entrepreneur, a good entrepreneur can succeed in any business.
But to dissuade your kids from going into the trades? Why? You also don't have to go into extreme levels of debt if you go into the trades.
Why do dentists have high levels of suicide rate? The fact that there are dentists out there making like 80k or less as a business owner despite putting in 60 hours per week, plus all the education, debt, and stress it takes to run business... then it starts to make sense.

 

[charlestweed]

It's terrible on your body. Being a GD in rural America, so many of my patients are in the trades and their knees and back are destroyed. One of my patients left the trades in his mid 30s for this reason.

Yup, many of these trade jobs require you to bend down, pick/lift up a heavy object, and get then get up using your knees. It’s like doing squat non-stop all day, but unlike a squatting exercise, you do it in poor body form, which will lead to hronic knee and back pain. In many cases, you have to lift bigger heavier item in order to get the job done faster and to avoid getting behind in the project. Sure, you can hire people to do the lifting for you but this will cut into your overhead....and have to deal with the labor law headache, worker comp, customers’ complaints etc.

 

[charlestweed]

Are you guys going to sit here and pretend like dentistry isn't hard on the body? I've got family member who is a multimillionaire as an electrician, he's in great physical shape in his 60s. He looks better than most dentists in their 60s. No hunched over back, and neck. He's probably made more money and had less physical ailments than the vast majority of dentists.
At the end of the day it really depends on who you are as an entrepreneur, a good entrepreneur can succeed in any business.
But to dissuade your kids from going into the trades? Why? You also don't have to go into extreme levels of debt if you go into the trades.
Why do dentists have high levels of suicide rate? The fact that there are dentists out there making like 80k or less as a business owner despite putting in 60 hours per week, plus all the education, debt, and stress it takes to run business... then it starts to make sense.

Dentistry is indeed very hard on your body as well. My wife gets a sore right thumb (from elevating/extracting teeth) that doesn’t go away. But it’s not as physically demanding as many of the trade jobs. It’s why you see most men, and very few women, are doing these tough trade jobs. I didn’t get a knee problem until I started doing my yard work (because I’m bored) 2 years ago….maybe, it’s just old age.

This is why I don't recommend older non-traditional students to pursue dentistry.

Debt is also a problem. Therefore, as soon as your kid is born, you should start the 529 college saving plan for him/her right away. IMO, getting a college education is important.

 

[New_Vegas]

Dentistry is indeed very hard on your body as well. My wife gets a sore right thumb (from elevating/extracting teeth) that doesn’t go away. But it’s not as physically demanding as many of the trade jobs. It’s why you see most men, and very few women, are doing these tough trade jobs. I didn’t get a knee problem until I started doing my yard work (because I’m bored) 2 years ago….maybe, it’s just old age.

This is why I don't recommend older non-traditional students to pursue dentistry.

Debt is also a problem. Therefore, as soon as your kid is born, you should start the 529 college saving plan for him/her right away. IMO, getting a college education is important.

I don't know man, dentistry is pretty physically demanding. I think you are downplaying how hard dentistry is on the body, and exaggerating how hard the trades are on the body.

Let's be honest here. Dentistry is very different now than when you started your career. I don't think you will ever understand the hopelessness and soul crushing of having 1 million in student loans like some specialists are now starting their careers with (including some people going into ortho). The job simply does not pay enough to justify that debt. I'm not speaking from experience, because I'm not even close to that amount of student debt - but I could see how I would be in a completely hopeless financial situation right now if that were the case.

So you entered the field with much, much less debt and had a much more favorable market than current grads. I've noticed how it's almost impossible for your generation to empathize with us because the situation was so much different than when you entered the field.

Not every kid is born with a silver spoon in their mouth, and not every dentist is going to be able to afford to fully fund a 529 for their kids. So to say college education is important... Yeah kinda. If the kid doesn't study underwater basketweaving it might be. Otherwise they may just be wasting their time and your money. Or robbing their own future with student loans to line the wallets of those who benefit from the corruption in academia.

 

[charlestweed]

I don't know man, dentistry is pretty physically demanding. I think you are downplaying how hard dentistry is on the body, and exaggerating how hard the trades are on the body.

Let's be honest here. Dentistry is very different now than when you started your career. I don't think you will ever understand the hopelessness and soul crushing of having 1 million in student loans like some specialists are now starting their careers with (including some people going into ortho). The job simply does not pay enough to justify that debt. I'm not speaking from experience, because I'm not even close to that amount of student debt - but I could see how I would be in a completely hopeless financial situation right now if that were the case.

So you entered the field with much, much less debt and had a much more favorable market than current grads. I've noticed how it's almost impossible for your generation to empathize with us because the situation was so much different than when you entered the field.

Not every kid is born with a silver spoon in their mouth, and not every dentist is going to be able to afford to fully fund a 529 for their kids. So to say college education is important... Yeah kinda. If the kid doesn't study underwater basketweaving it might be. Otherwise they may just be wasting their time and your money. Or robbing their own future with student loans to line the wallets of those who benefit from the corruption in academia.

I don’t disagree with you that dentistry is a physically demanding profession, unless you’re doing ortho or dental anesthesiology. Before you encourage your kid to get a trade job, instead of going to college, you should ask him to do work around the house like mowing grass, cleaning the backyard etc, and then ask him if is ok to do this every day as a full time job for the next 40+ years of his life. Plumbing is not just about connecting the pipes together. Electrical work is not just about connecting wires together. These jobs often require digging, crawling into tight crawl/attic space, breaking the thick concrete slabs, climbing, and cleaning up after the project as well. And like dentistry, you have to do many of the heavy lifting by yourself in the beginning and to establish good relationship with your clients before you can expand your business and become a successful multi-millionaire electrician like your uncle. Reputation can’t be built overnight....it requires a lot of hard work, time, and sacrfice.

You are right. We, older generation, had it much easier than the current generation. Even when I got paid half as much as a new grad as I make today, I was still able to buy a lot of things. I bought my first house for $380k. Now, this same house costs $1.5M. This is why I work hard to save for my son’s education so he will be at the same starting point as mine when I first started. You are also right that not every kid has wealthy parents to help out. IMO, dentistry is still worth it if one can keep the debt amount to around $300k or below (with some helps from their parents)

I had put in $400/month to the 529 plan for my son for about 3 years and the amount was enough to cover his college tuition + dorm + food for 1.5 years (5 quarters at UCLA) . The reason I stopped contributing after 3 years was I didn’t see the money grew fast enough and I thought I could get more by investing it real estate. My cousin has contributed a similar monthly amount to the 529 plan for his daughter since she was born and it’s more than enough to cover her entire 4 undergrad years at UCLA + maybe 1-2 yrs of professional school. His daughter is will apply for dental schools next year.

 

[yappy]

Are you guys going to sit here and pretend like dentistry isn't hard on the body? I've got family member who is a multimillionaire as an electrician, he's in great physical shape in his 60s. He looks better than most dentists in their 60s. No hunched over back, and neck. He's probably made more money and had less physical ailments than the vast majority of dentists.
At the end of the day it really depends on who you are as an entrepreneur, a good entrepreneur can succeed in any business.
But to dissuade your kids from going into the trades? Why? You also don't have to go into extreme levels of debt if you go into the trades.
Why do dentists have high levels of suicide rate? The fact that there are dentists out there making like 80k or less as a business owner despite putting in 60 hours per week, plus all the education, debt, and stress it takes to run business... then it starts to make sense.

It’s not nothing special if you look at analogous professions. I think the issue is the type of people who would go into a field like dentistry.

 

[2TH MVR]

You are right. We, older generation, had it much easier than the current generation. Even when I got paid half as much as a new grad as I make today, I was still able to buy a lot of things. I bought my first house for $380k. Now, this same house costs $1.5M.

And your grandparents probably paid a fraction for their house compared to the $380K you paid. And were wages back then the same as today? No. Curious if your grandparents felt they had it easier than your generation? Probably not.

Something has changed in the world of dental economics compared to the earlier years. Capitalistic greed on all fronts.

 

[Big Time Hoosier]

The real issue with housing is that the longterm historical average of median home price vs median income was around 3x, but it has since ballooned to nearly 6x. Homebuyers today absolutely have it worse off.

Big Hoss

 

[JacquesVallee]

The real issue with housing is that the longterm historical average of median home price vs median income was around 3x, but it has since ballooned to nearly 6x. Homebuyers today absolutely have it worse off.

Big Hoss

Unquestionably true. My dad bought his first home at 20. I can't even fathom that today. A new study just showed about half of parents now financially support their adult children. The America where you could hand your resume to a random CEO, give him a firm handshake, and get a job that pays enough to support a family is gone. 50% of parents financially support adult children, report finds. Here's how much it costs them.