Reality is in the Numbers!

[Cold Front]

If you look at the current big issues in this country, you can actually divide into 2 areas: what young people want and what old people want.

Young people want solutions to their student loans, and I mean not in the future, but today. Let’s look at how we got here in terms of outstanding student loans over the last 15 years:

2006: 0.5 Trillion (3.5% of GDP)
2007: 0.6
2008: 0.7 (Recession)
2009: 0.8
2010: 0.9
2011: 1.1
2012: 1.1
2013: 1.2
2014: 1.3
2015: 1.4
2016: 1.5
2017: 1.6
2018: 1.6
2019: 1.7
2020: 1.8 (Projected)
2021: 2.0 (Projected) (10% of GDP)

The student loans to gdp ratio went up from 3% to 10% (in just 15 years, pretty remarkable). This is a generational problem and it’s effecting 45-50 million Americans. The government is just kicking the can down the road but it will take that generation with high student loans to eventually run for office and bring around major reform - because the older generation doesn’t get it now.

What old people want is the opposite - Republican values. They care about the Economy (their savings, their jobs, their taxes, and anti-socialized medicine - because universal healthcare means more taxes). They have strong voting powers and are more engaged and active towards getting those issues addressed first, and student loans is way down the list for them.

The next election will probably tip towards what old people want, but in 8-12 years - all that could change with younger people having more voting blocks to change issues towards what they want.

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[2TH MVR]

how did your practice do during 2001-2003 and how was it compared to 2008-2009?

My practice did fine during 2001-2003. 2008-2009 was difficult. Eventually we all will make a financial mistake. At the peak of an economic boom 2007 I decided to build a second office. Invested close to a million dollars on real estate, build out and equipment. Paid too much. Add in the recession, patients not making their monthly payments, fewer patients. You get the picture. Not a fun time. Still own the office and real estate but never realized the potential I had planned for.

 

[Cold Front]

My practice did fine during 2001-2003. 2008-2009 was difficult. Eventually we all will make a financial mistake. At the peak of an economic boom 2007 I decided to build a second office. Invested close to a million dollars on real estate, build out and equipment. Paid too much. Add in the recession, patients not making their monthly payments, fewer patients. You get the picture. Not a fun time. Still own the office and real estate but never realized the potential I had planned for.

That’s also my worry now. I spent few million dollars between 2 practices and 2 commercial buildings they are in - but I have strong long term leases/tenants and healthy practices that supports them. All of my investments happened over the past 8 years, when the economy was in recovery phase from the last recession. If a recession happens in a year or so from now, which won’t be as bad as the 2008, I can weather it if all the indications/forecasts hold. But if I did all this back in 2007, I would probably get hit hard and possibly lose a lot of money, even everything. All other subsequent recessions will be ok with me, as I should retire all my debt by then.

 

[CGtoDentistry]

What old people want is the opposite - Republican values. They care about the Economy (their savings, their jobs, their taxes, and anti-socialized medicine - because universal healthcare means more taxes). They have strong voting powers and are more engaged and active towards getting those issues addressed first, and student loans is way down the list for them.

The next election will probably tip towards what old people want, but in 8-12 years - all that could change with younger people having more voting blocks to change issues towards what they want.

I think it really depends on the age range of the older people. For instance, Medicare is meant for those who are 65 and over correct? I'm sure there are tons of older people who don't want to see their Medicare go away.

 

[2TH MVR]

That’s also my worry now. I spent few million dollars between 2 practices and 2 commercial buildings they are in - but I have strong long term leases/tenants and healthy practices that supports them. All of my investments happened over the past 8 years, when the economy was in recovery phase from the last recession. If a recession happens in a year or so from now, which won’t be as bad as the 2008, I can weather it if all the indications/forecasts hold. But if I did all this back in 2007, I would probably get hit hard and possibly lose a lot of money, even everything. All other subsequent recessions will be ok with me, as I should retire all my debt by then.

As we both now ... it's all about timing. I still weathered the storm, but again .... just never realized the potential of my efforts. I will recoup most of what I put into the investment when I sell, but that amount will not cover all the years of effort that was put into that project.

 

[Cold Front]

I think it really depends on the age range of the older people. For instance, Medicare is meant for those who are 65 and over correct? I'm sure there are tons of older people who don't want to see their Medicare go away.

Yep. There is estimated 10,000 baby boomers that retire every day and qualify for Medicare. Since retirement means no money coming in from active revenues/a job. So retirees stay away from any expense that could burden their savings.... so that means Medicare is a good thing to have for the old folks.

There are about 45 million beneficiaries on Medicare today, and that is expected to go up as life expectancy continues to go up, with more old people tapping into Medicare. It’s interesting how these challenges will be solved in the long term. It will put an unimaginable strain on the economy if they are not addressed appropriately.

 

[CGtoDentistry]

Yep. There is estimated 10,000 baby boomers that retire every day and qualify for Medicare. Since retirement means no money coming in from active revenues/a job. So retirees stay away from any expense that could burden their savings.... so that means Medicare is a good thing to have for the old folks.

There are about 45 million beneficiaries on Medicare today, and that is expected to go up as life expectancy continues to go up, with more old people tapping into Medicare. It’s interesting how these challenges will be solved in the long term. It will put an unimaginable strain on the economy if they are not addressed appropriately.

Agreed. Things like Social Security/OASDI did wonders for making sure the elderly are provided for. It's sad to see elderly homeless people.

It's an interesting time. Especially with younger populations perceiving the baby boomers as even more entitled than they are. Automation can't solve everything either. For instance, caregivers can't be automated.

 

[Cold Front]

It's an interesting time. Especially with younger populations perceiving the baby boomers as even more entitled than they are. Automation can't solve everything either. For instance, caregivers can't be automated.

I’m kind of the middle generation in this and understand both sides. One generation will always be unhappy. If you put the shoe on the other foot, young people will not understand the generation choices the older folks are making. In my opinion, both sides made self-inflicted bad choices which has set up for some really bad expectations. Older people have not fixed some big issues (wealth gap, healthcare, student loans, etc) and obviously should not be surprised when young people see those decisions as wrong and failed expectations. Young people have also failed to be more organized as a generation, be more aggressive and put fire under their representatives feet, with the issues they care about. The blame level on both sides is getting worse, we will see how this plays out in the future.

 

[CGtoDentistry]

I’m kind of the middle generation in this and understand both sides. One generation will always be unhappy. If you put the shoe on the other foot, young people will not understand the generation choices the older folks are making. In my opinion, both sides made self-inflicted bad choices which has set up for some really bad expectations. Older people have not fixed some big issues (wealth gap, healthcare, student loans, etc) and obviously should not be surprised when young people see those decisions as wrong and failed expectations. Young people have also failed to be more organized as a generation, be more aggressive and put fire under their representatives feet, with the issues they care about. The blame level on both sides is getting worse, we will see how this plays out in the future.

Agreed. Rather than attacking each other should be finding better ways to improve our current climate and situation. I think the lack of organization from the younger generation leads to politicians like AOC - good at social media influencing/campaigning on ideas but lack resolution in implementation and execution of said ideas.

For instance, the idea of free college sounds awesome. Until we learn how to fund said college and determining if it's actually needed. If everyone goes to college it essentially becomes grades 13-16 and people go through the motions. And it doesn't increase anyone's odds of landing lucrative jobs. There'll always be some sort of distinguishable thing that helps people get higher paying jobs vs lower paying jobs.

In someways our European friends do better at preparing their populations for occupations, but there's a reason SV exists in California and not Germany. I've had European roommates here in NYC. The common mentality is you get your education, maybe a 1 year masters, then get a job as an account/engineer/finance person/doctor. And that's it. You just put in your time and then enjoy time outside of work more.

Whereas our system encourages innovation and rewards those who open businesses. It's not a wrong way of going about business, but I do enjoy that for us it's easier to change career fields. By and large my European counterparts are locked into career paths from the time they are teenagers

 

[Cold Front]

In someways our European friends do better at preparing their populations for occupations, but there's a reason SV exists in California and not Germany. I've had European roommates here in NYC. The common mentality is you get your education, maybe a 1 year masters, then get a job as an account/engineer/finance person/doctor. And that's it. You just put in your time and then enjoy time outside of work more.

The European economic model means more taxes to pay for entitlements. It’s different from the free-market and capitalistic model we have here. I lived in Europe, Britain, for 10 years, and although I agree with some European countries being a better place to study cost wise, there is a cap on opportunities and more taxes in the labor market. It’s a difficult world to have high incomes taxes and limited opportunities.

 

[CGtoDentistry]

The European economic model means more taxes to pay for entitlements. It’s different from the free-market and capitalistic model we have here. I lived in Europe, Britain, for 10 years, and although I agree with some European countries being a better place to study cost wise, there is a cap on opportunities and more taxes in the labor market. It’s a difficult world to have high incomes taxes and limited opportunities.

Totally agree. The number of Western European people I see on reddit who are dentists or tech workers (FAANG in Europe doesn't pay salaries equal to US) trying to immigrate to the US cause of our salaries...

 

[Cold Front]

Totally agree. The number of Western European people I see on reddit who are dentists or tech workers (FAANG in Europe doesn't pay salaries equal to US) trying to immigrate to the US cause of our salaries...

Yes. Things are about to get worse in Europe... economically. Hard Brexit happening in a month or so, Germany in recession, demographic problems - Europe is aging so fast that eastern European countries are losing population in the millions over the next couple of decades due to very low fertility. They are already experiencing Japan’s population collapse, which is about half a million people a year. We don’t have those problems yet! So the spread between US and Europe dental profession will be bigger in the short and long run... Europe will be further pushed to be more socialized medicine style, while the US can sustain the current free-market style healthcare over the next few decades. Hence why dentists in Europe are trying to migrate here.

 

[doctermined]

I am currently seeking new or recent graduates to join our team in Washington State were our average general dentist makes over 300k per year. I started my first practice along with a partner just over 7 years ago and have developed proven systems to generate massive new patient flow while keeping the office overhead below 40%. Our first year we collected over 1.2 million with a 42% overhead and we are now collecting just shy of 3 million with a 35% overhead still with just two doctors on an individual doctor 3 day work week at the original office. I would love to train a highly motivated go getter in all things necessary for success. Partnership opportunities start at 400k.

Are you still looking? What part of Washington?

 

[SoftGel]

This is why I'm totally against making dentistry something more than what it is right now. If people advocate for making dentistry required instead of elective, then the government will be pressured to intervene because it's perceived as a necessity rather than an elective procedure.

Are you saying the state of oral healthcare in the US is okay as it stands today? This may be blasphemy around here, but as future dentist I have no problem making less income than your generation, if it allows for a universal standard of minimum care. The well-off will find their gucci dental care somewhere regardless.

 

[Cold Front]

as future dentist I have no problem making less income than your generation, if it allows for a universal standard of minimum care.

No offense, but when you finish school and start working in the field - let us know if you would take that statement back.

 

[ToothJockey]

Are you saying the state of oral healthcare in the US is okay as it stands today? This may be blasphemy around here, but as future dentist I have no problem making less income than your generation, if it allows for a universal standard of minimum care. The well-off will find their gucci dental care somewhere regardless.

That's the kind of mentality that allows corporate and insurance to bully dentists and physicians.

 

[Big Time Hoosier]

a universal standard of minimum care

I believe that’s called a toothbrush and toothpaste. And too many people don’t even use them! I’ve always heard 80% of caries is found in 20% of people. Well that 20% needs to take some ownership of themselves!

If YOU won’t maintain a minimum of oral hygiene, why should I pay for YOUR crowns?!

Big Hoss

 

[Mr. Thirsty]

Are you saying the state of oral healthcare in the US is okay as it stands today? This may be blasphemy around here, but as future dentist I have no problem making less income than your generation, if it allows for a universal standard of minimum care. The well-off will find their gucci dental care somewhere regardless.

The government intervening rarely turns out the way that we want it to, even if the intentions are good. Medicaid fees are abysmally low in most states, even when compared to the lower reimbursing PPO's. Not to mention, as soon as dental care becomes a right and is funded completely by the government, you no longer own your craft. The government does.

Dentaltown - Where The Dental Community Lives®

Dentaltown is an interactive healthcare community working to connect dentists to their peers, dental service providers and manufacturers. Dentaltown has the most comprehensive online dental collection of dental forums, clinical cases, continuing education (CE) courses, magazine articles...

www.dentaltown.com

It's not just about making less income.

 

[knewstance]

The government intervening rarely turns out the way that we want it to, even if the intentions are good. Medicaid fees are abysmally low in most states, even when compared to the lower reimbursing PPO's. Not to mention, as soon as dental care becomes a right and is funded completely by the government, you no longer own your craft. The government does.

Dentaltown - Where The Dental Community Lives®

Dentaltown is an interactive healthcare community working to connect dentists to their peers, dental service providers and manufacturers. Dentaltown has the most comprehensive online dental collection of dental forums, clinical cases, continuing education (CE) courses, magazine articles...

www.dentaltown.com

It's not just about making less income.

That is really scary. It makes me not want to touch Medicaid, but in reality, I could see something similar happening with any insurance company.

 

[Mr. Thirsty]

That is really scary. It makes me not want to touch Medicaid, but in reality, I could see something similar happening with any insurance company.

The risk is there with insurance companies but they don't have the power that the government has. Both care about not overspending for procedures, but private insurances also care about overall profits. They are more likely to settle financially than to come raid your practice and try to send you to prison.

 

[TanMan]

Are you saying the state of oral healthcare in the US is okay as it stands today? This may be blasphemy around here, but as future dentist I have no problem making less income than your generation, if it allows for a universal standard of minimum care. The well-off will find their gucci dental care somewhere regardless.

That's exactly what I'm saying. How much less are you willing to sacrifice? 10%? 20%? 90%? Forced government redistribution of resources is probably one of the worst things that can happen to dentistry (or most anything besides projects that have large economies of scale with little return). Look at all these state medicaid programs, reimbursements, access to care, and abuses. It's similar to when people say, they are doing socialism wrong (after the millionth time), they just need to do it right. Look at where that ends up. The biggest victims here will be newly graduated dentists during a transition period of socialized dentistry. They will have significant amounts of debt without a market correction or adjustment of tuition and fees (which will not happen if government continues to prop up easy money for education) to compensate for declining incomes with socialized dentistry. The more you pay in taxes to redistribute the wealth for the sake of "equality", the more power you surrender to the government.

Here's what I think will happen if government mandated dentistry comes through. In order to appease and entice enrollment into a new government based program, unsustainably high fees (combined with increased utilization for things that are considered "free goods") and/or enrollment incentives will be provided. Things will go well until there's an economic downturn or election season is over. What happens will then be reduction in fees as utilization increases to meet budget shortfalls and/or gradual increase in taxation. As fees reduce, market inefficiencies will be introduced (and can be profited upon) due to supply not keeping up with demand. I believe at this stage, standard of care for that patient pool will be reduced as your "feel good standard/universal access to care" will be touted as a success. Now, you might ask why would the standard of care drop? Since running a dental office will cost the same, if not more due to inflation, and fees drop, costs have to be cut somewhere and with insurances/government already saying what is and isn't covered, they are already directing your treatment plan in one form or another. Hypothetically, if a dentist got reimbursed 20 dollars for a filling and 20 dollars for an extraction, the dentist would most likely have their hands tied and do the extraction since they would lose 10 dollars on a fill or they'd probably just do a ****ty filling with a 50mL tube of dual cure composite/3rd rate amalgam with no care for bonding or margins because it wouldn't be economically feasible to do so. This is happening with a lot of insurances already, trying to encourage extractions (because in their eyes, teeth are a liability) while trying to avoid covering procedures that may require replacement down the line (and this is negated with frequency limitations).

If this ever happens, what you refer to as "gucci dentistry of the future" will be the dentistry of today - the alternative higher standard of care compared to those on government insurance. Of course, the ones that will benefit from this are the people/companies that do the initial gold rush and leave when reimbursements drop/utilization enforcement kicks in. Just look at Texas Medicaid ortho before 2010.

So... if you still feel that government sponsored dentistry is great, then you should work at a free clinic to help bridge the gap. Some of us don't have the luxury of doing so.

The government intervening rarely turns out the way that we want it to, even if the intentions are good. Medicaid fees are abysmally low in most states, even when compared to the lower reimbursing PPO's. Not to mention, as soon as dental care becomes a right and is funded completely by the government, you no longer own your craft. The government does.

Dentaltown - Where The Dental Community Lives®

Dentaltown is an interactive healthcare community working to connect dentists to their peers, dental service providers and manufacturers. Dentaltown has the most comprehensive online dental collection of dental forums, clinical cases, continuing education (CE) courses, magazine articles...

www.dentaltown.com

It's not just about making less income.

Exactly. This is why I don't participate in government insurance. The government is a very powerful opponent that will drain your resources if they ever want to make an example out of you.

 

[Cold Front]

The risk is there with insurance companies but they don't have the power that the government has. Both care about not overspending for procedures, but private insurances also care about overall profits. They are more likely to settle financially than to come raid your practice and try to send you to prison.

The government doesn’t catch all fraud, probably 3% of all fraud at best due to funding requirements and limited enforcement, and they heavily rely on whistleblowers to help them catch those who commit fraud. Either way, fraud happens every where in the dental field, from embezzlements to under reporting income to the government. It’s just amazing how many dentists over treat and over bill patients - specially at many corporate settings that promotes these schemes. Medicaid insurance or not, only the big greedy people get caught - like dentists, physicians, and pharmacists who prescribed over 2,000+ opioids pills to 1 patient. Yes, that really happened!