Pros and Cons of practicing Dentistry in USA and Canada? How to decide?

[Moonlight_123]

Hi... I am a dual citizen of USA and Canada. I am completing my Dental School education in USA. I am so confused if I should practice in USA or Canada after my graduation. Can someone please help me out and share the pros and cons and if someone has been in the same position as me, what made you decide where to practice. I would greatly appreciate any help on this topic. Thank you.

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[Molar Whisperer]

My Canadian classmate is doing ~ $1.5 million (Canadian) working 3 days a week in a small town outside of Windsor, ON. There may be similar oversaturation of dentists in desirable areas but Canada has less dentists per capita. I haven't heard of many struggling Canadian dentists outside of Vancouver and Toronto metro areas. I believe taxes in Canada will be higher. In the US, insurances and liability may be higher. I believe overhead expenses may be similar. Canada may have more traditional fee per service payments compared to US where there are more PPO discounted reimbursements.

 

[Steins;Gate]

My Canadian classmate is doing ~ $1.5 million (Canadian) working 3 days a week in a small town outside of Windsor, ON. There may be similar oversaturation of dentists in desirable areas but Canada has less dentists per capita. I haven't heard of many struggling Canadian dentists outside of Vancouver and Toronto metro areas. I believe taxes in Canada will be higher. In the US, insurances and liability may be higher. I believe overhead expenses may be similar. Canada may have more traditional fee per service payments compared to US where there are more PPO discounted reimbursements.

Is this figure gross or net?

 

[Molar Whisperer]

Is this figure gross or net?

Gross. He takes home ~60%. I asked him about taxes and he really didn't give much info.

 

[Molar Whisperer]

From a few sources, it is much harder to obtain a Canadian license. I also heard they don't allow or make it harder for non-Canadians to get licensed. I believe in the US, they don't allow for dual citizenship so keep your dual status on the down low.

 

[dentistrydmd]

Likely the person above is referring to a dentist who owns his own practice, not an associate. This kind of situation is not the norm however.

One thing to consider is the exchange rate between Canada and the US. If you go to a more rural area, you will always do well regardless if you are in the US or Canada.

 

[Molar Whisperer]

Likely the person above is referring to a dentist who owns his own practice, not an associate. This kind of situation is not the norm however.

One thing to consider is the exchange rate between Canada and the US. If you go to a more rural area, you will always do well regardless if you are in the US or Canada.

Very true in both exchange rates and doing better in rural areas. From my observations, dentists can do better in Canadian rural areas. My classmate is the only dentist in the small town an hour away from his home in Windsor. In the US, you have to go more remote like over 2.5 to 3 hrs away from a desirable city. A town of 15k an hr away from my city has 25 dentists!

Correction, he was doing ~$1.5 million Canadian while working 4 days a week a few yrs ago. He had cut back to 3 days a week before Covid.

 

[dentistrydmd]

Very true in both exchange rates and doing better in rural areas. From my observations, dentists can do better in Canadian rural areas. My classmate is the only dentist in the small town an hour away from his home in Windsor. In the US, you have to go more remote like over 2.5 to 3 hrs away from a desirable city. A town of 15k an hr away from my city has 25 dentists!

Correction, he was doing ~$1.5 million Canadian while working 4 days a week a few yrs ago. He had cut back to 3 days a week before Covid.

From my experience meeting various dentists in the US and Canada, rural incomes are similar. Saturation levels in highly desirable areas like LA and NYC however are more saturated than other Canadian cities, but are not far off from levels in cities like Vancouver and Toronto.

 

[Molar Whisperer]

From my experience meeting various dentists in the US and Canada, rural incomes are similar. Saturation levels in highly desirable areas like LA and NYC however are more saturated than other Canadian cities, but are not far off from levels in cities like Vancouver and Toronto.

Very valid. My classmate doesn't understand the very high saturation of dentists in my Pacific NW area. Even rural areas within 1.5 to 2 hr drive away from my city have a lot of saturation. I believe it depends on the rural areas in the US. The rural areas in the US bread basket midwest and the poor SE may fare less saturation than high tech, coastal or recreational rural areas. I grew up in an undesirable rural area (my father was a foreign trained surgeon) and we were deprived of many amenities such as quality schools, shopping, restaurants, and recreational activities.

 

[Sublimazing]

Gross. He takes home ~60%. I asked him about taxes and he really didn't give much info.

that is an insanely good overhead for a general dentist...i’ve never heard of a GP who can approach that. In the US the average overhead is somewhere north of 65-75%...so your friend is beating them by at least 25%.

that tells Me that either your friend is doing something Almost no one else does...or they’re deceiving you about their income.

 

[lwergod]

that is an insanely good overhead for a general dentist...i’ve never heard of a GP who can approach that. In the US the average overhead is somewhere north of 65-75%...so your friend is beating them by at least 25%.

that tells Me that either your friend is doing something Almost no one else does...or they’re deceiving you about their income.

Does anyone know how overhead typically differes between US and Canada?

 

[Molar Whisperer]

that is an insanely good overhead for a general dentist...i’ve never heard of a GP who can approach that. In the US the average overhead is somewhere north of 65-75%...so your friend is beating them by at least 25%.

that tells Me that either your friend is doing something Almost no one else does...or they’re deceiving you about their income.

I knew about his lower overhead costs. In DS, he was a cheapskate and would try to stretch any costs to the max. What makes his overhead lower are no need to pay health insurance (socialized medicine), practicing in a town with less than 2k people (less property costs), probably no EMR and not using the latest and greatest. Canadian taxes will eat away a lot of your earnings though.

 

[OMSDoc]

I met an OMS (fellow Mayo OMS alumnus) who practiced in Alberta. He had osteoarthritis in his knee, and he could not stand up. He needed a knee replacement.

The waiting time for a knee replacement in Alberta was about 18 months. So, he was faced with being out of work for 18+ months, because he could not work if he could not stand up.

He took out a second mortgage on his house, came to the Mayo Clinic, and paid cash for his knee replacement.

He was back at work in less than 2 months.

 

[bones18]

Overhead varies based on practice location, rural vs. city, but is usually around 45-60%. As an associate in Canada the general going rate is 40% of collections and not production. Rural you can get 45% and sometimes even 50%. If you attended an accredited US school and passed the Canadian boards, it is not that hard to get licensed. Each province and territory is similar for requirements, aside from Quebec where there is a french language requirement. There is no NERB/ DERB/ ADEX in Canada and a lot easier to move from one province to another.

It's hard to have an apples to apples comparison, but talking among colleagues in the past, the US has the potential for to be more lucrative, but there is more risk involved ie. a lot more lawsuits.

 

[Mauricio45]

Here in Canada, the norm for pay is usually 40% on COLLECTIONS. Some places that are more rural offer 45% or even 50% sometimes even on PRODUCTION. I've noticed in the States, it really varies in which region of the country you're in. I've also noticed in the States, it's very common for associates to have daily minimums which is unheard of here in Canada. I think daily minimums is a great thing and don't understand why it's not popular here in Canada.

Also, virtually every associate in Canada is an independent contractor. It is unheard of to be classified as an employee in Canada, yet it is common in USA.

 

[lwergod]

Here in Canada, the norm for pay is usually 40% on COLLECTIONS. Some places that are more rural offer 45% or even 50% sometimes even on PRODUCTION. I've noticed in the States, it really varies in which region of the country you're in. I've also noticed in the States, it's very common for associates to have daily minimums which is unheard of here in Canada. I think daily minimums is a great thing and don't understand why it's not popular here in Canada.

Also, virtually every associate in Canada is an independent contractor. It is unheard of to be classified as an employee in Canada, yet it is common in USA.

honestly, the Canadian system sounds better

 

[Mauricio45]

honestly, the Canadian system sounds better

Hmm. Another thing I've noticed is that in the US, even though some places they offer low % (i.e. 25%, 30%) they at least offer a base salary. I.e. paid on percentage or base salary (whichever is higher). Base salary is rare in Canada. Not to mention, in the States, because many associates are employees, they do get benefits which is unheard of in Canada because associates here are contractors.

I think just being paid on % collections is risky because what if office is not busy enough? Otherwise, you're just sitting in the office twiddling your thumbs. It's happened to me. At least, with base salary, you have something to fall back on. Plus, the owner will be more incentivized to fill associate schedule if paid on a salary or base. They don't want to pay associate for just sitting there doing nothing.


I think being paid on % collections is ridiculous though. It's not associates job to collect money for the office. Associate should be paid for what they do (i.e. on production).

 

[Fernad92]

I graduated in May of 2020 at NYUCD. I have friends in Canada and the USA all over the place practicing.
Honestly, state to state varies so much but even within major cities like NYC and Jersey City it varies a lot. The starting salary for a dentist in NYC is about 500 a day. However, my closest friend there has seen job postings consistently offering 300 a day which is disgraceful. Jersey is the same but its easier to get full time work. Any new grads in New York are working 2-4 part time jobs in multiple offices. It is very tough the first few years out. I do not think Canada is that different overall. However, jobs in Texas and Florida are paying extremely well right now. The exodus from big cities to those low tax freedom friendly states is very real for every profession right now.

 

[PerioDont]

I met an OMS (fellow Mayo OMS alumnus) who practiced in Alberta. He had osteoarthritis in his knee, and he could not stand up. He needed a knee replacement.

The waiting time for a knee replacement in Alberta was about 18 months. So, he was faced with being out of work for 18+ months, because he could not work if he could not stand up.

He took out a second mortgage on his house, came to the Mayo Clinic, and paid cash for his knee replacement.

He was back at work in less than 2 months.

why would an OMFS need to take a second mortgage out to pay for a knee replacement surgery? they must have been in quite a bind financially.

quick googling shows roughly fifty thousand dollars cost. even then, I figure an OMFS should have that much saved up if he has been out of residency for a bit