Practicing dentist LECOM grad AMA

[Stanelz]

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Every now and then I like to come back here and see how things have changed and offer any advice I can.

Any questions about Lecom or practicing dentistry in the real world? Ill be around for a couple days

 

[Chief's Pineapple]

Are you practicing in FL or another state? Big city, the burbs, rural, or something else? How easy was it to secure employment? Do you like where you are at now? Has being an RDA given you more appreciation for other staff?

 

[Stanelz]

Are you practicing in FL or another state? Big city, the burbs, rural, or something else? How easy was it to secure employment? Do you like where you are at now? Has being an RDA given you more appreciation for other staff?

I practice in Dallas, TX where I am originally from. Suburbs very middle class demographic. I work at a comfort dental practice doing bread and butter dentistry and making 2x more than my counterparts (with more stress because I and my partners manage the practice vs a DSO taking care of everything for you while also taking half your pay check). My route isn't for everyone but it is quite a bit more lucrative if you're willing to work hard and keep a cool head under pressure. Having been an RDA it has given me the ability to connect with my staff in a way that no other doctor can, is it absolutely necessary? no but its helping a lot.

 

[zToothinator]

Did you consider an AEGD/GPR?
What CE do you hope to take over the coming years?

 

[Stanelz]

Did you consider an AEGD/GPR?
What CE do you hope to take over the coming years?

I considered one for a bit but realized that everyone who does those brag about all the skills they learned as they never use them again. How many people who did an aegd or GPR are doing sedation or complicated prosth or placing implants or doing tons of molar Endo, some but I think its far less than you might think. Those things (imo) are better learned through CE. I spent a lot of time in dental school practicing molar Endo on extracted teeth because I love Endo which is now paying huge dividends as I have already started doing molar Endo in my first month as a dentist. I want to do more surgery CE and implant CE maybe down the line. The type of practice you are in will dictate what you should take. I for one would probably never take an aesthetics or veneer course personally unless I moved to a different type of practice. Practice Endo as much as you can in dental school on extracted teeth, it will take you from normal dentist income to a new tier quickly.

 

[zToothinator]

What’s your plan for loan repayment?
Do you think you’ll be with Comfort Dental/a DSO long term or want to open your own practice?
From chatting with your classmates, what’s your opinion of fair compensation for a new grad?

 

[Stanelz]

What’s your plan for loan repayment?
Do you think you’ll be with Comfort Dental/a DSO long term or want to open your own practice?
From chatting with your classmates, what’s your opinion of fair compensation for a new grad?

My plan is to pay it down aggressively over ten years while also investing in retirement and assets. My income is considerably higher than my classmates and my fiancé (soon to be wife) also makes a good income as a health care worker so I will be able to do this much quicker than most (again while also working way harder than most). DSOs will give you somewhere around 120-140 but remember Uncle Sam takes 25% and if you're graduating with 350k+ in loans youre going to be paying a minimum payment of 3-4k per month in student loans a lot of people dont realize this until they graduate and their dreams are crushed because they thought they were going to buy a mansion and a supercar because they are "supposed to be" rich.

 

[Stanelz]

Also to anyone that is going the DSO route there is no shame, some people need that first. When negotiating, make them pay your moving costs and focus on a higher percentage of production instead fo higher daily guarantee. I promise you that you will make way more than their guarantee even though it seems like a lot as a dental student.

 

[Stanelz]

Also I see myself with comfort dental for 5-10 years. Its a lot of work and a lot of money but I dont think my body or mental health could do it forever.

 

[zToothinator]

Thank you for sharing!

 

[cluelessdr]

when you say practice endo on ext teeth. are you just doing the access prep or actually instrumenting and obturating? also for comfort dental what is your title? can any new grad get this title and "work harder and get paid more" like you are saying? thanks!

 

[Stanelz]

when you say practice endo on ext teeth. are you just doing the access prep or actually instrumenting and obturating? also for comfort dental what is your title? can any new grad get this title and "work harder and get paid more" like you are saying? thanks!

Access and get to working length, the rest of Endo is pretty straightforward and uses way to much material for you to be practicing on extracted teeth. If you put a tooth in alginate, you can practice using an apex locator because it works for some reason. It will help you get the feel for negotiating tough canals and calcifications. If you perf, no biggy its an extracted tooth


Comfort dental is a partnership, you buy into an existing practice or buy out another doctor. I am one of 3 doctors in my office, we own the office and run it. Any new grad can work hard and make more but when you own a practice you keep everything minus the over head vs a DSO where they take a percentage of your production after overhead.

 

[Chief's Pineapple]

So you're at a DSO, but you're partnered into a specific practice location? Are you only at that location or do you have to commute to other locations? Do you get along with your partners? Pardon all my ignorance, but I was under the impression that banks didn't loan out money to buy unless you had some liquidity laying around? Was this hard to do as a new graduate?

 

[Stanelz]

So you're at a DSO, but you're partnered into a specific practice location? Are you only at that location or do you have to commute to other locations? Do you get along with your partners? Pardon all my ignorance, but I was under the impression that banks didn't loan out money to buy unless you had some liquidity laying around? Was this hard to do as a new graduate?

Comfort dental is the overseeing "DSO" but each location is bought and franchised by the owner doctors, similar to buying a fast food franchise. Comfort dental takes a small portion of collections and in return provides marketing and low cost labs and supplies. I own 1/3rd of the location I work at and run it like a group private practice. I dont work at any other office and no one works at my office except me and my two partners. My partners and I make all the calls as far as staff, supplies, scheduling, etc. Normally its next to impossible to get money from a bank for a practice right out of school but comfort has relationships with banks that can get you funded, albeit at a higher interest rate but you can refinance after a few years and the upside is really high compared to working as an employee somewhere else even though your interest rate is higher than a traditional practice loan. I had no cash or assets whatsoever when applying. You can almost think of it like buying, owning, and selling a house. You purchase but can sell at any time similar to a house even though you aren't done paying off the loan.

 

[Chief's Pineapple]

That was very helpful, thank you. I'm assuming you work 5 days a week? What's the chances or likelihood of going to 3-4 days a week with two other partners?

 

[Stanelz]

That was very helpful, thank you. I'm assuming you work 5 days a week? What's the chances or likelihood of going to 3-4 days a week with two other partners?

I work M-F and two Saturdays a month. If we ever opted to add a fourth partner we would be working less hours maybe one Saturday a month. Our clinic (as with all comfort dental locations) is open 7:30am-7:30pm M-F and 7:30am-1:30pm Saturday. Doctors work 6 hours shifts so in a typical day ill either be working morning or afternoon either by myself or with one other partner. Our exam and X-rays fee is only $19 and our prices are typically lower than any other clinic so our schedules are always filled with new and existing patients. You work harder because your prices are lower but you also earn a lot more than most offices because of this. I get patients all the time that come in because every other dentist office is closed when they get out of work or because it was only $19 for me to see them. Often times that $19 initial visit turns into a few thousand dollars in treatment. Of course youll have some patients that come in for the low price just because they need an extraction and dont want anything else but im not gonna be one of those dentists that is too proud to accept low fees for certain procedures if it keep my schedule full and produces a higher overall income at the end of the month. I can't imagine myself working this hard forever but while im young its a good way to pay off loans and bills and gain a ton of experience before moving on to something more stable after 8-10 years. There are doctors that stay in this system their whole career as well because it is so lucrative.

 

[zToothinator]

When you move on to something more stable, will you need to sell your portion of the business? Or can you hire an associate in your place and take part of the production?

 

[Chief's Pineapple]

Do you have hygienists? Do you take HMOs or Medicaid (or have the choice to do so or not)? Am I understanding correctly that it's just like being an associate at a DSO, except that you own so you take a bigger chunk of cash home? Would you be comfortable sharing the percentage of overhead of your practice?

 

[PerioDont]

What is the maximum amount of student loans you would recommend taking out for dental school?

 

[Stanelz]

When you move on to something more stable, will you need to sell your portion of the business? Or can you hire an associate in your place and take part of the production?

typically its just a straight sale

 

[Stanelz]

Do you have hygienists? Do you take HMOs or Medicaid (or have the choice to do so or not)? Am I understanding correctly that it's just like being an associate at a DSO, except that you own so you take a bigger chunk of cash home? Would you be comfortable sharing the percentage of overhead of your practice?

We have a hygienist although most comfort dentals dont, our particular location is quite busy and can afford one. We dont take HMO's and we take medicaid if we want to, its up to the individual doctor. I personally take it because even though the reimbursement sucks it keeps me busy on days when my production isn't super high, ill do a few fillings here or there, which is nice. If it ever got to the point where it was causing me to burn out then I would just refer it all to peds. It is not like being an associate at another DSO because the ownership you get at other DSO's is completely fake and they can kick you out at any moment. They'll never give you complete ownership of the practice you "own." At comfort dental my partners and I own 33.3% each and comfort dental owns 0%. Yes they have rules but they can never force you to sell or take it from you like other DSOs can. At other DSO's youll own 49% and they'll always own the majority and will still take a bigger cut of your collections. There are definitely some cons that I won't go into fully here such as having to use the comfort dental lab only and not being able to use your practice as collateral for a mortgage. Our overhead is typically in the mid to upper 40's because we share all the expenses and run high volume. Typical private offices are running mid to upper 50's which when youre talking about hundreds of thousands of dollars of revenue is a LOT of extra income going to overhead which is coming directly out of your pocket as an owner. The average comfort dental doctor in 2021 made $399,000 (this is public information thats why Im sharing it). I won't go into any more specifics about my particular practice just to keep things confidential on behalf of my partners.

 

[Stanelz]

What is the maximum amount of student loans you would recommend taking out for dental school?

max recommended? $0 😆

realistically though anything below 250k is a decent place to be. 250-350 is manageable. 350-450 gets tough. 450+ I hate to say it but you are really crippling your future finances because even if you are making minimum payments its going to take a large chunk of your income.

If you are at USC or NYU racking up 600+, you are in serious trouble because that is not a hole thats easy to get out of.

 

[Blueshirts]

Nice to see you still giving back to the SDN community, I always enjoyed seeing what you would post over the years. Goodluck

 

[Stanelz]

Always happy to help! ill be around a few more days for any more questions about life after dental school

 

[pubhealthdent]

What's your daily or monthly average production?

 

[Stanelz]

What's your daily or monthly average production?

Im not going to give too many specifics about my personal situation but id say the floor on my daily production is 1.5k

 

[pubhealthdent]

Im not going to give too many specifics about my personal situation but id say the floor on my daily production is 1.5k

Just curious how you're making 2x your counterparts on 1500/day? That math doesn't seem to add up

 

[PerioDont]

Just curious how you're making 2x your counterparts on 1500/day? That math doesn't seem to add up

Yeah 1500 per day and production is really low. Maybe by floor they mean that’s the least they produced?

You can’t really keep an associate with those numbers

 

[Stanelz]

Just curious how you're making 2x your counterparts on 1500/day? That math doesn't seem to add up

1500 floor meaning it would never go below that. 1500 would be a day when im not doing any production really (exams, emergencies, maybe a couple fillings, seat crowns, etc). This also doesn't include my partners. In a typical day when im doing crowns, root canals, and quads of fillings it is much much higher than that. I work 5-6 days a week, 6 hours a day and me and my two partners share all expenses/overhead so our productions is extremely high on a normal basis and our costs are extremely low.

 

[pubhealthdent]

1500 floor meaning it would never go below that. 1500 would be a day when im not doing any production really (exams, emergencies, maybe a couple fillings, seat crowns, etc). On a typical day it is much much higher than that. I work 5-6 days a week, 6 hours a day and me and my two partners share all expenses/overhead so our productions is extremely high on a normal basis and our costs are extremely low.

So what is "extremely high" production numbers? Just trying to figure out what kind of production can be accomplished when you're wasting time on $19 NP exams.

 

[Stanelz]

So what is "extremely high" production numbers? Just trying to figure out what kind of production can be accomplished when you're wasting time on $19 NP exams.

Im not sure if you're being facetious but by me "wasting time" on $19 exams it usually turn into multiple thousand dollar treatment plans because its a low cost of entry for someone searching "dentist near me" online. Because our exam price is so low I see about 30 new patients a month and some fizzle out and become one and done extractions but many of them turn into 3-4k treatment plans. Again I won't go into specifics because I think its unnecessary but its not uncommon to have multiple days each week of 4-5K+ in production

 

[pubhealthdent]

Im not sure if you're being facetious but by me "wasting time" on $19 exams it usually turn into multiple thousand dollar treatment plans because its a low cost of entry for someone searching "dentist near me" online. Because our exam price is so low I see about 30 new patients a month and some fizzle out and become one and done extractions but many of them turn into 3-4k treatment plans. Again I won't go into specifics because I think its unnecessary but its not uncommon to have multiple days each week of 4-5K+ in production

Not being facetious at all. We charge about $200 for NP exams, and most of those turn into $2k+ in treatment (FQHC, so most need like 15 fillings or extractions and dentures). I just can't really imagine people searching for the cheapest possible NP exam are the crowd most likely to agree to those higher cost treatment plans

 

[Stanelz]

Not being facetious at all. We charge about $200 for NP exams, and most of those turn into $2k+ in treatment (FQHC, so most need like 15 fillings or extractions and dentures). I just can't really imagine people searching for the cheapest possible NP exam are the crowd most likely to agree to those higher cost treatment plans

you'd be surprised my friend. Not all of those patients convert into reliable patients that are ready to spend thousands but because we have sheer volume of people coming through our doors from the low exam fee, enough of them do convert to keep us extremely busy. I practice in a very middle class area so I have a mix of lower middle class that want extractions only and upper middle class that has enough disposable income to spend a few thousand over the course of a few months. I dont need 30 new patients to accept a huge treatment plan, I only need a few each month and because our costs are significantly lower, people are more likely to shop around and then come back. I work harder than most (my crowns are only ~850 so I have to do 2 for every other dentists' 1), but the payoff is worth it because of the volume. Its not sustainable for a whole career and as I mentioned I dont see myself doing this forever but for now its a really great gig as a young motivated dentist. In summary, volume +low prices+ low overhead)

 

[Stanelz]

I also want to mention that because were open 730am-730pm and 730am-1:30pm Saturdays we get a TON of patients that literally have no where else to go at those times. Because there is three doctors its not overwhelming for us because we only work 6 hours a day and 2 Saturdays a month (which gives as a ton of new patients that can only do Saturdays). Also we offer multiple forms of financing through third party health care credit cards which is controlled entirely by our front staff and office manager. Its not too much on any one of them because we have a ton of staff to share the responsibility but since we share all expenses, having a ton of staff to keep this giant operation going doesn't hit our bottom line super hard like it would at a one doctor practice.