Perio Residency

[TimR]

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Anyone here have any legit information on getting into perio residencies. I keep hearing about how it is not competitive at all to get into them. Anyone have an idea of what kind of stats you would need?

thanks
tim

 

[IcedOMFS]

Anyone have an idea of what kind of stats you would need?

An IQ < 75

 

[toofache32]

An IQ < 75

...and an accent.

 

[charlestweed]

Anyone here have any legit information on getting into perio residencies. I keep hearing about how it is not competitive at all to get into them. Anyone have an idea of what kind of stats you would need?

thanks
tim

It is not very competitive to get in. However, if you apply to programs that offer stipent, it may be a little bit harder to get in. My wife got accepted to all programs that she applied, except UCLA. At that time, UCLA still offerred stipent... I am not so sure about now. National board scores of 90 (part I ) and 85 (partII) would make you a very competitive applicant.

Since implant dentistry has become more popular, and tooth loss caused by perio dz is still prevalent, periodontics is currently a thriving specialty. A lot of GP's don't do bridges anymore since it is easier (and more profitable) to restore implants. GP's are always very appreciative, when my periodontist wife comes to their office to show them how to restore implants (from taking impression to final crown placement).

And yes, a lot of perio residents, including my wife, have an accent. But this has helped her. A lot of Hispanic patients (predominantly in California) prefer seeing dentists who have an accent because they think these dentists are less arrogant and more caring. These patients are, of course, wrong...but that's the general perception. They are helping her living the American dream.

I hope this helps.

 

[psiyung]

You have to smell of curry

 

[TimR]

well, I have a pretty thick californian accent and I actually LOVE curry. the only problem is my fleshy white skin and red hair. honestly, I really want to get into perio, but i Am getting so many mixed messages

 

[charlestweed]

Having practiced in the real world for 6 years in multiple practices, I'd like to share with you guys my best estimate on specialists' salaries in California:

1. GP: an avg salary of an associate dentist (2-3 year experience) is about 500 dollars/day.
2. Pedo: make about 1000-1500 dollars/day
3. Ortho: most orthodontists (2-3 year experience) in Calif. work &#189; of their time at their own practice and the other &#189; at other offices as associate orthodontists. Their daily average is about 2000-2500 dollars/day.
4. Endo: it is a little bit harder to find associate position so most have their own practice. Most GP's refer out HMO pts who need endo to endodontist&#8230; this means high volume of patients per day. They make about 2500-3000/day
5. OMFS: a lot newly grad OS's (all 5 of my friends from UCLA, USC) work for big companies like SmileCare, Newport Dental, Western Dental. They work nonstop from 7AM-3PM and do a ton of 3rd molars under IV. They get certain percentage of their overall production&#8230;so the net gain is roughly between 4000-6000/day. Sometimes, it can go as high as 10000/day.
6. Perio: a lot of GP's love to have in-house perio to do implants, osseous surg., and crown lengthening for them. Periodontists make about 1000/day.
7. Prosth: I have no idea.

The bottom line is: if you specialize, you can easily finish paying off your student loans w/in the first 5 years....own a decent home and a first mercedes benz w/o needing an additional income from your spouse.

So Tim, do you still want to be a periodontist?

 

[Meatwad]

Having practiced in the real world for 6 years in multiple practices, I'd like to share with you guys my best estimate on specialists' salaries in California:

1. GP: an avg salary of an associate dentist (2-3 year experience) is about 500 dollars/day.
2. Pedo: make about 1000-1500 dollars/day
3. Ortho: most orthodontists (2-3 year experience) in Calif. work &#189; of their time at their own practice and the other &#189; at other offices as associate orthodontists. Their daily average is about 2000-2500 dollars/day.
4. Endo: it is a little bit harder to find associate position so most have their own practice. Most GP's refer out HMO pts who need endo to endodontist&#8230; this means high volume of patients per day. They make about 2500-3000/day
5. OMFS: a lot newly grad OS's (all 5 of my friends from UCLA, USC) work for big companies like SmileCare, Newport Dental, Western Dental. They work nonstop from 7AM-3PM and do a ton of 3rd molars under IV. They get certain percentage of their overall production&#8230;so the net gain is roughly between 4000-6000/day. Sometimes, it can go as high as 10000/day.
6. Perio: a lot of GP's love to have in-house perio to do implants, osseous surg., and crown lengthening for them. Periodontists make about 1000/day.
7. Prosth: I have no idea.

The bottom line is: if you specialize, you can easily finish paying off your student loans w/in the first 5 years....own a decent home and a first mercedes benz w/o needing an additional income from your spouse.

So Tim, do you still want to be a periodontist?

Is this info anecdotal? If so, an OMFS working 5 days a week is pulling in 1.04M-1.56M per year (assuming the 10k/day is an outlier and is very unlikely to be a normal daily haul, because factoring 10k/day for 5 days a week @ 1 year is 2.6M which seems downright incredible). I knew OMFS paid real well, but over a million a year? This must be for someone who works like crazy, has a very estalished practice, well-known in the area, etc. etc., right?

 

[Bifid Uvula]

Is this info anecdotal? If so, an OMFS working 5 days a week is pulling in 1.04M-1.56M per year (assuming the 10k/day is an outlier and is very unlikely to be a normal daily haul, because factoring 10k/day for 5 days a week @ 1 year is 2.6M which seems downright incredible). I knew OMFS paid real well, but over a million a year? This must be for someone who works like crazy, has a very estalished practice, well-known in the area, etc. etc., right?

Most OMFS in private practice will see on a daily average 5-10 cases of Impacted 3rds under Sedation/General Anesthesia. This averages about $1400-1800 a pop where I live. Throw in a good number of implants and bone-grafts each week and that number is EASILY attainable. The key to financial success in OMFS is to stay in the office and stay the hell away from the hospital.

Other factors come into play in the OMFS office as well. Instrument costs are relatively high initially (good instruments that are properly used and maintained will go a long way), but the most significant costs come from anesthesia. Depending on the technique/drugs used, the overhead can be substantially different between practicioners.

The sky is the limit whether you are a GP or any specialist. Its all a matter of finding a successful business model and remaining ethical too. Do what you love and the $$$ will come...

 

[charlestweed]

The salary figures that I mentioned earlier are only for California. Of course, not all ortho, OMFS, and endo are wealthy everywhere in the US. I know a struggling orthodontist in Utah, who has to fly to Arizona to work there 2days/ week to support his slow practice.

The OMFS salary that I mentioned earlier is the starting salary for rookies (all of my OS friends are rookies and they are in their mid 30). Can't imagine how much OS's make after 10+ years&#8230;&#8230;probably enough to retire in some Newport Coast mansions.

 

[Meatwad]

The salary figures that I mentioned earlier are only for California. Of course, not all ortho, OMFS, and endo are wealthy everywhere in the US. I know a struggling orthodontist in Utah, who has to fly to Arizona to work there 2days/ week to support his slow practice.

The OMFS salary that I mentioned earlier is the starting salary for rookies (all of my OS friends are rookies and they are in their mid 30). Can't imagine how much OS's make after 10+ years&#8230;&#8230;probably enough to retire in some Newport Coast mansions.

Well, this would certainly explain the stiffness of the competition for OMFS!

Another quick question, if I may. Are all these OMFS' you know in Cali DDS/MD's? I've heard a lot of people doing OMFS residencies opt for the MD/6 year residencies over the certificate/4 year programs if they plan on Cali for insurance reasons or something of that nature. Any credibility to this?

 

[charlestweed]

The scope of practice for a 4 year DDS and 6 year DDS,MD is the same. In several multispecialty offices where I work and used to work, I often see 4 year OS leaving and the position was subsequently replaced by another 6 year MD OS and vice versa. I think the OMFS residents are better at answering this question&#8230;.I am only an orthodontist.

To me, these surgeons deserve the kind of salary that I talked about. OMFS residency is very stressful. Most people do not want to spend another 4- 6 years of hell after having to deal with all kinds of horrible things in dental school. I witnessed a girl dropped out of her OS residency a month after she started. I saw another OS resident dropped out and applied for orthodontic residency. I saw still another filing for a divorce during his omfs residency.

 

[Meatwad]

The scope of practice for a 4 year DDS and 6 year DDS,MD is the same. In several multispecialty offices where I work and used to work, I often see 4 year OS leaving and the position was subsequently replaced by another 6 year MD OS and vice versa. I think the OMFS residents are better at answering this question….I am only an orthodontist.

To me, these surgeons deserve the kind of salary that I talked about. OMFS residency is very stressful. Most people do not want to spend another 4- 6 years of hell after having to deal with all kinds of horrible things in dental school. I witnessed a girl dropped out of her OS residency a month after she started. I saw another OS resident dropped out and applied for orthodontic residency. I saw still another filing for a divorce during his omfs residency.

Yeah, not surprising; general surgery intern year is no joke.

 

[IcedOMFS]

the most significant costs come from anesthesia. Depending on the technique/drugs used, the overhead can be substantially different between practicioners.

I sometimes wonder about that. Certainly "new" drugs like midazolam and propofol and sevo are great... But then you see really old guys still using butterfly needles with diazepam (not even diazemuls) and pentothal, as a direct injection (ie. not hanging a bag of crystalloid). That's some pretty cheap anesthesia overhead. I wonder if their patients even know the difference...

In theory you would see more thrombophlebitis with diazepam, headaches with pentothal, and people totally snowed for the next two days... But maybe it doesn't matter...

 

[Yellowman]

I sometimes wonder about that. Certainly "new" drugs like midazolam and propofol and sevo are great... But then you see really old guys still using butterfly needles with diazepam (not even diazemuls) and pentothal, as a direct injection (ie. not hanging a bag of crystalloid). That's some pretty cheap anesthesia overhead. I wonder if their patients even know the difference...

In theory you would see more thrombophlebitis with diazepam, headaches with pentothal, and people totally snowed for the next two days... But maybe it doesn't matter...

this is true...one of our attendings was telling us a story of a local omfs who was sued for thromophelebitis using the technique that you described. Butterfly, valium and penthothal with no bag hanging. After the sx, pt noticed a 'hard knot' that wouldn't resolve at the IV site. A friend of the pt (who is a RN) suggested that the dentist must have broke off the cathether off of an angiocath...thus the knot. Basically to make the long story short, pt underwent multiple vascular surgeries to remove this supposed angiocath that was lost in her veins, which was of course never found because the oral surgeon used a butterfly. My attending was the expert witness at his trial, and despite a very convincing testimony by him explaining that the angiocath could not have been left behind because a butterfly was used, the jury still awarded the pt a sizeable settlement. Go figure😕

 

[scalpel2008]

this is true...one of our attendings was telling us a story of a local omfs who was sued for thromophelebitis using the technique that you described. Butterfly, valium and penthothal with no bag hanging. After the sx, pt noticed a 'hard knot' that wouldn't resolve at the IV site. A friend of the pt (who is a RN) suggested that the dentist must have broke off the cathether off of an angiocath...thus the knot. Basically to make the long story short, pt underwent multiple vascular surgeries to remove this supposed angiocath that was lost in her veins, which was of course never found because the oral surgeon used a butterfly. My attending was the expert witness at his trial, and despite a very convincing testimony by him explaining that the angiocath could not have been left behind because a butterfly was used, the jury still awarded the pt a sizeable settlement. Go figure😕

our standard anesthesia consents for IV sed don't have phlebitis listed as a possible complication but i always add it. That being said i rarely use valium.

 

[scalpel2008]

Is this info anecdotal? If so, an OMFS working 5 days a week is pulling in 1.04M-1.56M per year (assuming the 10k/day is an outlier and is very unlikely to be a normal daily haul, because factoring 10k/day for 5 days a week @ 1 year is 2.6M which seems downright incredible). I knew OMFS paid real well, but over a million a year? This must be for someone who works like crazy, has a very estalished practice, well-known in the area, etc. etc., right?

i know plenty of oms netting >1 mil /yr

 

[perioenvy]

Is anyone applying to perio programs and getting interviews yet? I just want to know where I stand with the schools. My applications are in.

 

[PFM]

I thought this was a perio thread

 

[TimR]

So,
If perio residents are on average making almost twice what GP's are making, why isn't there more competition to get into perio residency's?

Is the work of periodontist (SRP) so crappy that people won't even do it for the money?

 

[vize]

TimR, yes it is interesting that perio is one of the least competitive specialties, but I think it's mainly because perio is a 3 year residency. since it's a surgical type of specialty, most people are like, 'hell, I can just go into oral surgery for 1 more year and be able to do a lot more.' By the way, i don't know of any periodontists unhappy with their work.

 

[charlestweed]

Only newly grad. ortho and OMFS can easily find 5days/week jobs in California. It is a little bit harder get full time jobs for other specialties, including perio. This is ok for us since I only want my wife to work 3 days/week (she used to work 6 days/week before we had kids). At first, I thought my wife chose a wrong specialty. However, my wife has proven me wrong&#8230;. and we thank the Lord every day for our success.

Implantology has saved the perio specialty. In two multispecialty practices where my wife works, she usually diagnoses, does implant treatment planning and places most of the implants while her OS colleague in the same practice does a lot of wisdom teeth and other types of surgeries. It seems like OS in such setting do not care too much about implants since extractions of 3rd molars yield a much higher production.

Tim R, it might be very hard to set up a perio office from scratch in California. My wife was lucky to buy an existing practice. As I mentioned earlier, there are a lot of GP's who want to hire periodontists&#8230;.Of course, a lot of periodontists don't like to see their perio colleagues working for GP's as in house periodontists&#8230;. But hey, you gotta do what you gotta do in order to survive in this competive market.

 

[QCkid]

A friend of mine that finished here at USC not to long ago made something in the range of 130k to 140k (in a month) by the time he had been out for just a few months. He is one of only a few of OS guys in Wyoming.

 

[HenryH]

Only newly grad. ortho and OMFS can easily find 5days/week jobs in California. It is a little bit harder get full time jobs for other specialties, including perio. This is ok for us since I only want my wife to work 3 days/week (she used to work 6 days/week before we had kids). At first, I thought my wife chose a wrong specialty. However, my wife has proven me wrong…. and we thank the Lord every day for our success.

Implantology has saved the perio specialty. In two multispecialty practices where my wife works, she usually diagnoses, does implant treatment planning and places most of the implants while her OS colleague in the same practice does a lot of wisdom teeth and other types of surgeries. It seems like OS in such setting do not care too much about implants since extractions of 3rd molars yield a much higher production.

Tim R, it might be very hard to set up a perio office from scratch in California. My wife was lucky to buy an existing practice. As I mentioned earlier, there are a lot of GP’s who want to hire periodontists….Of course, a lot of periodontists don’t like to see their perio colleagues working for GP’s as in house periodontists…. But hey, you gotta do what you gotta do in order to survive in this competive market.

Is periodontics really that hard to make a good living in? Is it like the "pathology" of the dental industry -- where there just isn't much work going around or something? Just curious, since I've heard a few people talking about how periodontics can get rough...

 

[vize]

Is periodontics really that hard to make a good living in? Is it like the "pathology" of the dental industry -- where there just isn't much work going around or something? Just curious, since I've heard a few people talking about how periodontics can get rough...

No.

 

[armorshell]

Is periodontics really that hard to make a good living in? Is it like the "pathology" of the dental industry -- where there just isn't much work going around or something? Just curious, since I've heard a few people talking about how periodontics can get rough...

That's funny, I would have though oral pathology was the "pathology" of the dental industry.

 

[backaction]

For the most part perio is not hard to get into. There are a handful of programs where below 90 means doom. Slightly above average boards should be fine (87-90) for most.

As a new grad you can expect to make 120-220K/year working 4 days. Recent grad friends that I know (one makes slightly over 200, the other about 180 working 4 days). Working for a dental mill will bring you around 200 working 4 days.

For many, dental school perio left a foul taste behind. Perio was basically a cock block from doing fixed and getting the hell out. Then there are those who could get into any specialty, but are happy doing general. Most programs are expensive and you can just do another year and do 4 year OMFS and get paid. The two specialties while they have some commonalities are completely different. The perio residency is easy compared to OMFS. There is a lot of reading required in perio and it's probably a harder residency than ortho, endo or peds, but this highly depends on the program.

Most perio residents are happy with what they are doing and I think most periodontists enjoy their speciality. Without implants though, perio would be basically hopeless. There are a few periodontists that don't place them, but if you are a new grad you have to in order to make it. GPs love having them in-house and you can do well that way without having to deal with high start up costs and the stresses of running an office.

 

[toofache32]

...For many, dental school perio left a foul taste behind. Perio was basically a cock block from doing fixed and getting the hell out.....

Exactly. I never even considered Perio because I feared I would become a spineless a$$hole like all the Perio faculty at my school. Nevermind the fact that it took them an hour to lay a flap.

 

[PFM]

Exactly. I never even considered Perio because I feared I would become a spineless a$$hole like all the Perio faculty at my school. Nevermind the fact that it took them an hour to lay a flap.

umm...because if you don't do crown lengthening or get the inflammation under control before you do fixed prost, it would be called malpractice...but i guess graduating is more important than that pesky "standard of care" thing huh?

PS providing quality dentistry = spineless a**hole...twisted

 

[toofache32]

umm...because if you don't do crown lengthening or get the inflammation under control before you do fixed prost, it would be called malpractice...but i guess graduating is more important than that pesky "standard of care" thing huh?

PS providing quality dentistry = spineless a**hole...twisted

I'm talking about doing occlusal amalgams on 20yo patients with 2-3mm probing depths who simply have plaque (when you stain it with that pink stuff) on greater than 10% of tooth surfaces. This would automatically buy the patient a "bring them back again in 2 weeks and let's stain it again" delay from the Perio faculty.

 

[PFM]

I'm talking about doing occlusal amalgams on 20yo patients with 2-3mm probing depths who simply have plaque (when you stain it with that pink stuff) on greater than 10% of tooth surfaces. This would automatically buy the patient a "bring them back again in 2 weeks and let's stain it again" delay from the Perio faculty.

If thats the case then I agree, that's ridiculous. What school did you go to so I know where not to apply.

 

[charlestweed]

I'm talking about doing occlusal amalgams on 20yo patients with 2-3mm probing depths who simply have plaque (when you stain it with that pink stuff) on greater than 10% of tooth surfaces. This would automatically buy the patient a "bring them back again in 2 weeks and let's stain it again" delay from the Perio faculty.

Yeah, some perio instructors are ridiculous like that. Instead of doing that, they should teach students how to diagnose and treat perio dz&#8230;..so these students will know when or when not to refer pt to periodontist once they graduate from dental school. This probably explains why not so many GP refer patients to periodontists.

Lack of GP's referral makes a lot of people think periodontics is a dying specialty. Because of this, patients continue to lose their teeth from perio dz&#8230;.and implant placement (about &#189; of all the surgical procedures at my wife's practice) has become more common in a perio practice.

A lot periodontists (and other specialists as well) choose to work for someone else rather than setting up their own practice b/c most of them owe a lot of student loans. They can still earn decent salary (usually 1000/day for a rookie). If you place a lot of implants (3, 4 implants per day) and split 50/50 with your GP boss, you can bring home more money than ortho, pedo and endo.

If you want to work 3 days a week and still make the same as, or a little bit more than, your referring GP who works 5-6 days a week, then periodontics is not a bad choice.

 

[toofache32]

Lack of GP’s referral makes a lot of people think periodontics is a dying specialty. Because of this, patients continue to lose their teeth from perio dz….and implant placement (about ½ of all the surgical procedures at my wife’s practice) has become more common in a perio practice.

I think the reason patients are losing teeth is the same as always....toothbrush allergy. You can't teach an old dog new tricks. Many people just won't brush their teeth. That's why the only true cure for Perio is a #150 forceps.

 

[vize]

If you want to work 3 days a week and still make the same as, or a little bit more than, your referring GP who works 5-6 days a week, then periodontics is not a bad choice.

This is why many females apply to this specialty. They want to have kids, raise a family, and generally aren't willing to work as hard. This probably hugely contributes to the reason why the periodontist average salary is below other specialties.

 

[backaction]

Many of you wanted to know which ones are good.

San Antonio is highly regarded. Seattle was highly regarded, but it's fallen. Rochester, Connecticut, Maryland, Stonybrook, MUSC.

Michigan or USC is you like research and lots of literature.

Bad ones: Boston (the entire first year is research only). Good if you enjoy research a lot. Tufts is weak. St. Louis, southern ill or kansas...forgot which one, but heard that they don't do implants in perio.

USC if you like only using autogenous bone and no membranes or allograft.

A lot of perio is semantics. Lots of it is minutiae and clinically has little to know relavance. Perio likes to talk for hours about open contacts and plunger cusps and likes to classify everything. I read a lot of the journals and a lot of the papers are worthless. Unfortunately there isn't enough novel work being done. Some of the more important perio work being done isn't even in perio journals. You have to look into journals on lipid research etc.

 

[Wayne Coronado]

I'm talking about doing occlusal amalgams on 20yo patients with 2-3mm probing depths who simply have plaque (when you stain it with that pink stuff) on greater than 10% of tooth surfaces. This would automatically buy the patient a "bring them back again in 2 weeks and let's stain it again" delay from the Perio faculty.

I'm glad our perio dept. did not pull that $hit. Sure, we had our roadblocks (mainly graduation requirements), but overall they did not interfere (or delay) other needed treatments unless it made objective sense to do so. Of course, even if the situation like the one you described occurred, I would nod my head as if I understood and then still get restorative coverage for the next appointment. I would just make sure to look at who's covering on what days (the faculty coverage schedule soon became my best friend) and work around that perio faculty, if possible. I did this in other areas when I was at odds with a particular faculty's treatment philosophy. To be fair, this only happened a few times.🙂

 

[charlestweed]

Many of you wanted to know which ones are good.

USC if you like only using autogenous bone and no membranes or allograft.

"Autogenous bone graft" is the unique feature of USC perio. For small grafts, they use bone scrapper to harvest bones from the surrounding bone and for larger grafts, they get blocks of bone from chin or ramus. For huge ones, they usually refer to OS for hip graft. So at USC, you don't see membranes, cadaver bones, alloderm (gingival graft) etc. That's what USC teaches&#8230;. but you can do whatever you want when you graduate&#8230;it is so easy to use bottle bones. Why not learn the hard way when you are in training?

Another strong feature of USC perio is that perio and prosth residents are required to attend weekly conference together. So at USC, perio residents learn a lot about restorative treatment planning. This is very important especially when you work as an in-house periodontist in a GP office. You can help your GP boss with the restorative treatment plan for patients who need a few or full mouth implants.

Three bad things about USC perio: 1. too expensive and 2. very hard to get a MS degree and 3. The director and part time instructors are very strict.

 

[TimR]

anyone want to comment on how they see the future of perio as a specialty? I hear some mixed messages on this. According to Arthur Ashman (the NYU dept of Implants is named after him) Periodontists will be the specialists who will dominate the implant field. I know that its being spread around though

 

[IcedOMFS]

anyone want to comment on how they see the future of perio as a specialty? I hear some mixed messages on this. According to Arthur Ashman (the NYU dept of Implants is named after him) Periodontists will be the specialists who will dominate the implant field. I know that its being spread around though

That's BS perio propaganda. Dominate the implant field my a$$. Arthur Ashman can F right off, along with the rest of the Pee pees.

The real future dominatrix of implant dentistry will be the general practitioner...

 

[charlestweed]

anyone want to comment on how they see the future of perio as a specialty? I hear some mixed messages on this. According to Arthur Ashman (the NYU dept of Implants is named after him) Periodontists will be the specialists who will dominate the implant field. I know that its being spread around though

No, OS usually get more implant referrals from the GP and prosth than periodontists. Nobody can predict the future of periodontics. The good news is that implant dentistry has become more popular. And this is good for both OS and perio. However, there are a few implant classes in California that show GP's how to place implants.... and this is no good.:cry: My wife has lost a couple of referrals b/c of these classes. However, she still gets to do more challenging cases ie multiple posterior implants, anterior implants, implants that require bone grafts, and full mouth implants.