Recent Graduate--Ask me Anything

[italianstallion2008]

I remember coming to this website time and time again in the early days of dental school. I wanted to take the opportunity to pop in and offer my willingness to share some of the early returns since I finished dental school and started practicing.

I graduated dental school in May 2018 and started working soon after. I gave a lot of thought to pedo while in dental school but ultimately decided against specializing immediately and entered general practice as an associate.

I practice in a rural community 30 minutes outside of a metropolitan area of about 1.5 million people.

I work M-F from 8-4pm seeing about 6-8 patients a day plus hygiene. I am compensated at a daily rate of $600/day or 30% production, whichever is higher. All lab costs are paid by the owner. After 1 year I will have an opportunity for a buy-in.

That should get things rolling. Ask me anything! And thanks again to all those who came before me.

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[italianstallion2008]

Investigating all my possibilities led me to appreciate the potential partnership that could exist with my current owner. A group practice model is most consistent with my long-term plans. Because I liked the owner, another associate, the area, and the numbers I was comfortable starting as an associate. I was also willing to sacrifice immediate owner income for the security of being an employee with a favorable compensation plan and the ability to focus on enhancing my clinical ability. Like anything, everyone is comfortable with their own level of risk. Personal choice.

Current set-up is two offices. Four docs. I'm in the second, a recent acquisition. Previous owner sold to mine. She wanted a career change and severely underproduced (limited hours/days) for the potential that exists. 5 ops. 1 surgical suite. 2 hygienists.

I graduated with $150k debt, which includes a used car purchase, leftover loans from my wife's undergrad, and costs associated with having a baby while in dental school.

I'm optimistic about the future potential of this practice/area. I've enjoyed my relationship with the owner and my patients to this point. I'm sure honeymooning from dental school has plenty to do with it. 5 years out goals though.. student loans paid, a healthy start to retirement earnings, 15 year fixed mortgage (we're renting now), and ownership stakes in both our offices and another two which we hope to bring on board in the next couple years. We're content to live like residents now for the options to open up great financial opportunity down the line.

 

[cloth_alert00]

6 patients/day in 8 hours, seems pretty low stress. Do you find yourself rushed at all?

 

[O Gaúcho]

Are you often paid the daily rate of $600/day or does the 30% of production exceed that $600? What has your best day been? What is your projected income? And did you have similar or better job offers? thanks!

 

[italianstallion2008]

Very manageable for a new doc. The owner is stressing quality over quantity in terms of my development which has made for a really great transition from dental school in the early going. I am in a private practice with primarily cash/PPO patients so not dependent on volume production. When I see what I produce at the end of the day compared to how hard I feel I've worked I'm pretty amazed/grateful. Never feel like I'm spinning my wheels or totally overwhelmed. Excited to ramp things up as I become more proficient, but at the same time I'm not that interested in seeing a multitude of patients every day. So far I schedule about 40 min for a restoration, 1hr for 2, etc. 1.5 hours for crown and bridge. I did a full mouth EXT today so gave myself some extra time for that.

 

[PreDent_Eagle]

Did you get hired before you graduated or before? Some d4s I know signed contracts before graduation

 

[italianstallion2008]

Are you often paid the daily rate of $600/day or does the 30% of production exceed that $600? What has your best day been? What is your projected income? And did you have similar or better job offers? thanks!

I'm paid $600 if I produce less than $2000 on a given day. Once I exceed $2000 production, instead of being paid $600, I'm paid 0.3 x my production. Today for example my production was $4,813, so my take home was 0.3 x $4,813 or $1,444.

Can't recall what my best day has been off the top of my head.

I've worked 37 days so far with a YTD of $34,348.

 

[italianstallion2008]

Did you get hired before you graduated or before? Some d4s I know signed contracts before graduation

I signed a letter of intent in the fall of my D4 year. At the end of D3 I finally decided against pedo or a GPR and started searching for an employment opportunity. I spent most of the summer talking to docs across several states my family was interested in living in before eventually meeting the doctor I'm currently working with. After a lot of discussion he invited me to his practice for a week (I was living in another state at the time). Returned from the trip with an offer letter and signed on a couple weeks later. It was a huge relief to head into the CDCA/Part 2 Boards/end of dental school with the most important thing (employment!) already in the bag.

 

[HKSZYU]

150k debt is quite low these days. Did you go to a Texas school? If not, how were you able to keep your debt load so low? On a similar note, what is your current repayment schedule? Have you/do you plan to refinance?

 

[italianstallion2008]

Does your boss have a track-record of mentoring associates long-term? What is the turnover rate for associates? You say you are comfortable working with him. Were you drawn to his clinical skills or something else like above average compensations? How many days per week does the owner practice dentistry? Are you hired as an independent contractor? If not, what is your benefit package like?

I am the first new grad associate he has hired. Since owning he has traditionally worked with older docs close to retirement age. One of them did retire, opening up an opportunity for me. In making the transition to me or someone else the hope was to bring on younger doctors looking to build something together.

As far as being comfortable, it was most important to me to evaluate our relationship through the lens of future partners as docs and businessmen. Probably not the greatest comparison, but I feel like I treated it similarly to the way you might get to know or date the type of person you think you'd want to marry someday.

Does he have a similar treatment philosophy? What's his personal life like? Do we have other common interests? Do I believe he is ethical and full of integrity? Can I trust him to treat me fairly? Will he be patient with my initial shortcomings? Is he willing to teach? Etc. So for me it was less about the nuts and bolts of dentistry or up-front pay and more about playing the long game. Could I trust my hunch on the long game enough to take the initial plunge?

He practices 4 days a week. I am W-2. Benefits are pretty lean. I can take off as much as I want and set my own schedule at my expense. Paid federal holidays (daily min). Malpractice. CE stipend.

 

[italianstallion2008]

150k debt is quite low these days. Did you go to a Texas school? If not, how were you able to keep your debt load so low? On a similar note, what is your current repayment schedule? Have you/do you plan to refinance?

No just a regular old public state school. I did not know this at the time that I enrolled, but my school has a huge scholarship fund and offers many annual scholarships for academic/clinical performance, research, community involvement, etc. They also award subsidized loan packages primarily based on need. I'd have to count them all up but over four years I saved around 100k that way. When you're researching the schools you may want to attend I would definitely ask about what type of endowment they have or the involvement of their alumni society.

Aside from that. Live like a dental student. Not a dentist. And make sure your spouse/potential spouse is on the same page. Don't be intimidated by the extravagant living of wealthier classmates. Consider cost of living as part of your decision for dental school. We lived in a cheap city with lots of cheap entertainment. Read The White Coat Investor. Much easier read than biochem.

In large part because about $40,000 of my loans are subsidized for 6 months - 1 year after graduation, I am not paying anything yet. I currently save $1,000 a week, which by the end of July will leave us with a $10k emergency fund. Starting in August I'll start putting that $1,000 toward a down payment or other savings. Once I am no longer in deferment I will probably test the market on refinancing to see what kind of interest rate is available. Depending on what it is, aggressive paydown to just be rid of it (I hate being in debt) or drag it out as long as possible at a low interest rate and invest in retirement. I do not pretend to be an expert on finances. In that regard I'm soliciting all the best advice I can find and am open to suggestion.

 

[Faux]

Since you transitioned right from school to practice, were there any skills that you weren't taught in school that you had to be quick to learn? How are your removable cases coming along?

 

[DMD.DDS.2016]

Most new associates I know (in good areas/rural) start with the daily minimum of $600/day but this is for a start up period like 6 months to a year until you get busier. Is your $600 minimum guaranteed indefinitely?

Also, you state that you get paid a percentage of your production. Most associates get paid on collections which is less or far less than production $. I’m curious if your set up means “production” = collections? You mention PPO/cash patients but are most patients paying cash?

 

[2TH MVR]

Sounds like you've done everything right. Graduated with little DS debt and now work in a rural community. Was working in a large city even an option? Or did you make the decision to work rural based on what you heard or learned from SDN?

 

[italianstallion2008]

Since you transitioned right from school to practice, were there any skills that you weren't taught in school that you had to be quick to learn? How are your removable cases coming along?

I wasn't always thrilled with my dental school experience, but I will credit them to having prepared me pretty well from a surgical and removable standpoint. I was able to do several complete and partial dentures in school and got quite a bit of training in oral surgery for routine extractions and enough exposure in surgical extractions that I feel mostly comfortable. Surgery and removable has always made sense to me, and experience is an excellent teacher.

I do not feel that I was prepared adequately for endo at my dental school. It is easily the procedure that I derive the least amount of satisfaction from. Our practice has an endodontist that comes once a week for our molar endo, and our patients can have BU/Crown prepared the same day, which is a convenience they appreciate. As time goes on we will see how things change, but as far as letting what interests me the most guide my CE.. implant training and laser dentistry (the owner keeps a waterlase here) are at the top of my list. Watching my endo work so quickly/exactly with the scope makes me appreciate the service my patients are receiving. For now I'm happy to keep her busy and reap the $ rewards of a clean BU/crown prep.

 

[italianstallion2008]

Most new associates I know (in good areas/rural) start with the daily minimum of $600/day but this is for a start up period like 6 months to a year until you get busier. Is your $600 minimum guaranteed indefinitely?

Also, you state that you get paid a percentage of your production. Most associates get paid on collections which is less or far less than production $. I’m curious if your set up means “production” = collections? You mention PPO/cash patients but are most patients paying cash?

The minimum is indefinite, but things will be restructured when you factor in a potential buy-in next year. The owner wants us both to be continuously incentivized to keep me productive.

Adjusted production is probably the most appropriate term. Reimbursements for insurance patients are lower than our standard fee when you factor in the penalties for network participation, but frequently not by much. One reason I chose this area was for the high reimbursements. But regardless of the fee I'm just paid the day I produce it regardless of when/how much of that fee is ultimately collected.

A significant portion of our patient demographic is made up of geriatric, cash paying patients.

 

[italianstallion2008]

Sounds like you've done everything right. Graduated with little DS debt and now work in a rural community. Was working in a large city even an option? Or did you make the decision to work rural based on what you heard or learned from SDN?

I grew up in a small town about 2 hours from the closest major city so for me working here feels like home. If anything it feels bigger with the city only a half hour down the highway. I love the freedom that comes with living in a small town in terms of purchasing power and your opportunity to buy land and use it as you please. Love the outdoors. I walk outside my front door and have a pond full of large-mouth and a kayak drop in that heads out to sea. So rural dentistry is just the dream for me. Throw in the fact that I can earn a high income as well and it's really a no-brainer.

 

[Hnl7]

Thanks for the AMA!

Do you have any tips for making the most out of dental school?

Are there any particular things you wish you had taken advantage of while you were enrolled?

Do you have any general tips for incoming D1’s?

Thanks a lot and best of luck!

 

[italianstallion2008]

Sounds solid. Mind if I ask how much you get for CE stipend? Are you planning on picking up a new advanced procedure in the near future to be the staple of your practice (eg molar endo and crown, extractions and implant placement&restoration etc), if so in what area? Any plans to incorporate CAD/CAMs or other high-tech gadgets? Or are you more planning on sticking to bread and butter (fillings/crown&bridge) and increasing efficiency? What is your operatory and equipment set up like loupes mag etc? Do you use isolite and intraoral cameras? Last but not least, does your boss cover your health, dental, vision, and disability? Does your malpractice insurance have a tail coverage? Any retirement savings plans offered by your boss?

I do restore implants, training I received in dental school. It has not taken long to get excited about implant placement. Particularly with our patient demographic I'm anxious to learn and get started on some straightforward cases. Thankfully the boss is extremely supportive. I mentioned my current status with endo somewhere up above.

We currently digitally scan our crown/bridge and Invisalign cases. The scans are then uploaded to our lab guy who mills our crowns for delivery. We also have a laser in our surgical suite utilized for a variety of treatments. I like to take case photos moreso than my boss does. It's definitely a beneficial tool not just for the patient but for my benefit as well. I'm fortunate in that he lets me order whatever supplies I like rather than forcing me to work within his system. I do not use isolite. Rubber dam forevs! I do use a loupes and light. 3.1x Perioptix and a Lumadent light.

All that being said, it's really just been fantastic to be in the real world providing a great service to a grateful population doing bread and butter dentistry. That's the good life. In dental school you are so conditioned it seems to feel that you don't know enough or are never quite prepared enough to just get out there and get to work. For my personal growth, just getting into the game and hitting the grind has done wonders for my confidence. Being well compensated for that service is gravy. Tasty delicious gravy of course. I'm so excited for all that there is for me to learn, but at the same time, it hasn't taken long in practice to realize how much I really do already know. So in that regard, thanks dental school. I really am grateful.

Get an occurence policy for malpractice. Dental is free. I pay for my own health insurance and disability policy. No retirement plan. Those benefits are awesome if you can get them, but if not I would take a higher % pay and plenty of patients over a cushy benefits package. Life insurance is cheap, disability perhaps a little less so. If I can't have it all I'd rather just have the freedom to be able to work as hard as I want to make a great living for myself. Power in personal freedom. Again that's just me. To each his own. But if you can negotiate for it, right on!

 

[deleted659902]

I do restore implants, training I received in dental school. It has not taken long to get excited about implant placement. Particularly with our patient demographic I'm anxious to learn and get started on some straightforward cases. Thankfully the boss is extremely supportive. I mentioned my current status with endo somewhere up above.

We currently digitally scan our crown/bridge and Invisalign cases. The scans are then uploaded to our lab guy who mills our crowns for delivery. We also have a laser in our surgical suite utilized for a variety of treatments. I like to take case photos moreso than my boss does. It's definitely a beneficial tool not just for the patient but for my benefit as well. I'm fortunate in that he lets me order whatever supplies I like rather than forcing me to work within his system. I do not use isolite. Rubber dam forevs! I do use a loupes and light. 3.1x Perioptix and a Lumadent light.

All that being said, it's really just been fantastic to be in the real world providing a great service to a grateful population doing bread and butter dentistry. That's the good life. In dental school you are so conditioned it seems to feel that you don't know enough or are never quite prepared enough to just get out there and get to work. For my personal growth, just getting into the game and hitting the grind has done wonders for my confidence. Being well compensated for that service is gravy. Tasty delicious gravy of course. I'm so excited for all that there is for me to learn, but at the same time, it hasn't taken long in practice to realize how much I really do already know. So in that regard, thanks dental school. I really am grateful.

Get an occurence policy for malpractice. Dental is free. I pay for my own health insurance and disability policy. No retirement plan. Those benefits are awesome if you can get them, but if not I would take a higher % pay and plenty of patients over a cushy benefits package. Life insurance is cheap, disability perhaps a little less so. If I can't have it all I'd rather just have the freedom to be able to work as hard as I want to make a great living for myself. Power in personal freedom. Again that's just me. To each his own. But if you can negotiate for it, right on!

Sounds like you have it together man. Congrats on the great start to your career. Gotta ask though. How did you go about signing the contract? Does it include any non-compete clause within a certain radius should you decide to work elsewhere or open up your own nearby? What kind of professionals did you hire during the transition process from a dental school grad to an associate dentist? I'm assuming an attorney specializing in dental practice and a dental CPA and maybe even a CFA. Did you network at all during the summer between D3 and D4 with supply reps?

 

[AKtoTXstudent]

Sounds like you have it together man. Congrats on the great start to your career. Gotta ask though. How did you go about signing the contract? Does it include any non-compete clause within a certain radius should you decide to work elsewhere or open up your own nearby? What kind of professionals did you hire during the transition process from a dental school grad to an associate dentist? I'm assuming an attorney specializing in dental practice and a dental CPA and maybe even a CFA. Did you network at all during the summer between D3 and D4 with supply reps?

Great questions, I am anxious to hear the answer

 

[AKtoTXstudent]

I do restore implants, training I received in dental school. It has not taken long to get excited about implant placement. Particularly with our patient demographic I'm anxious to learn and get started on some straightforward cases. Thankfully the boss is extremely supportive. I mentioned my current status with endo somewhere up above.

We currently digitally scan our crown/bridge and Invisalign cases. The scans are then uploaded to our lab guy who mills our crowns for delivery. We also have a laser in our surgical suite utilized for a variety of treatments. I like to take case photos moreso than my boss does. It's definitely a beneficial tool not just for the patient but for my benefit as well. I'm fortunate in that he lets me order whatever supplies I like rather than forcing me to work within his system. I do not use isolite. Rubber dam forevs! I do use a loupes and light. 3.1x Perioptix and a Lumadent light.

All that being said, it's really just been fantastic to be in the real world providing a great service to a grateful population doing bread and butter dentistry. That's the good life. In dental school you are so conditioned it seems to feel that you don't know enough or are never quite prepared enough to just get out there and get to work. For my personal growth, just getting into the game and hitting the grind has done wonders for my confidence. Being well compensated for that service is gravy. Tasty delicious gravy of course. I'm so excited for all that there is for me to learn, but at the same time, it hasn't taken long in practice to realize how much I really do already know. So in that regard, thanks dental school. I really am grateful.

Get an occurence policy for malpractice. Dental is free. I pay for my own health insurance and disability policy. No retirement plan. Those benefits are awesome if you can get them, but if not I would take a higher % pay and plenty of patients over a cushy benefits package. Life insurance is cheap, disability perhaps a little less so. If I can't have it all I'd rather just have the freedom to be able to work as hard as I want to make a great living for myself. Power in personal freedom. Again that's just me. To each his own. But if you can negotiate for it, right on!

Also, thank you for doing this thread. Incoming D1 here and I appreciate reading about your experiences. What made you decide against a GPR or AEGD?

 

[Jlm50]

Loving all the information here..

Where did you look for job openings? Indeed, craigslist? Is there a site specifically for dental professionals?

 

[serendipity30]

Without any support from the outside, how did you manage your living expenses?

I heard it's pretty hard to do anything(working) besides study while you are in school.

 

[italianstallion2008]

Without any support from the outside, how did you manage your living expenses?

I heard it's pretty hard to do anything(working) besides study while you are in school.

My wife and I worked during undergrad. After we paid school debts, we had about $20k left over at the start of dental school. She worked for most of D1 (~$30k) before deciding she wanted to get another degree before we moved away from a university/had kids. She was in school for an additional two years, we had a baby, and then she worked for about the last 6 months or so of D4. So there was some spouse income spread around to pay to help pay for her school, a baby, etc.

We lived in married student housing ($600 month all utilities/internet included). I rode a bike to school. For entertainment we mostly took advantage of all the festivals/cheap entertainment from the city we lived in. The university subsidized tickets to a lot of local venues. I remember us seeing West Side Story for $15/ticket. After the first year of dental school and feeling out what our costs could be, we sat down and came up with a debt number that we wanted to shoot for and designed our budget accordingly. Whenever we got a bonus or an unexpected scholarship, we just lowered our number by that amount rather than splurge with it.So we were very frugal, but I don't feel like we never had any fun either. When we graduated a couple months ago, we found that we still had some loan money leftover and since we were under our number we decided to use it to take a trip to Europe and blew it all. Trip of a lifetime. Big splurge. But we enjoyed every minute because we stuck to our guns in dental school.

I think I mentioned earlier, but I would really recommend considering the location of your dental school as part of criteria. If we were living in Chicago, NYC, San Fran, etc, it would have been a different story for us.

 

[italianstallion2008]

We talking tasty sausage gravy with biscuits or nasty brown cafeteria gravy?

Also, thank you for doing this thread. Incoming D1 here and I appreciate reading about your experiences. What made you decide against a GPR or AEGD?

Haha. A mix of Bob Evans and Cracker Barrel gravy for sure.

My pleasure. Good luck with your education.

The right residency program can be a fantastic experience and absolutely worth it. I could probably have done a GPR and not regretted it.

Basically, what it came down to was that it was just "time" if that makes sense. For me personally, it was just time to jump in and get to work. Time to throw myself in the fire. With a wife that had sacrificed with me for 4 years and a new baby, it was time to help provide for my family. Time to not be in school, at least for a while.

I learn much better by just doing something than by having a lecture or seminar about it. I do not consider myself to be of excellent clinical ability. Above average probably, but I am not a wizard with a handpiece yet. Pretty good like I said at oral surgery. But I did recognize that I had pretty excellent bedside manner and I did not lack confidence. My patients liked me and trusted me. So I just felt like it was "time." I was okay with the idea of getting very comfortable with the meat and potatoes of general dentistry before going wild with advanced services. I thought if I could make $150k my first year the extra $100k earned over doing a GPR would be worth the opportunity cost of what I personally would have gotten out of it.

Personal choice. I'm happy so far. Still honeymooning. Talk to someone who is doing a GPR and he/she will tell you it's the greatest experience of his/her education. And both of us would be right.

 

[italianstallion2008]

Loving all the information here..

Where did you look for job openings? Indeed, craigslist? Is there a site specifically for dental professionals?

I wasn't really interested in working for a dental corporation, which is what you will find predominantly on the websites you mentioned.

State Dental Association classified sections can be pretty good. My dental school had a good network across the state for finding good positions. I would definitely contact dental supply reps (Henry Schein, etc). These are the guys that are on the ground and in dental offices all the time. They have a good idea of what offices are killing it and which ones might not actually be ready for an associate right away. They also may know about opportunities in chatting with their clients before those opportunities actually become public. So definitely make it a point to get to know those reps who come to your school as suppliers. Become friendly with them and have them keep their eyes out for you. I'd say that's a better use of your time than brown-nosing with your anatomy instructor, but that's just me.

 

[italianstallion2008]

Sounds like you have it together man. Congrats on the great start to your career. Gotta ask though. How did you go about signing the contract? Does it include any non-compete clause within a certain radius should you decide to work elsewhere or open up your own nearby? What kind of professionals did you hire during the transition process from a dental school grad to an associate dentist? I'm assuming an attorney specializing in dental practice and a dental CPA and maybe even a CFA. Did you network at all during the summer between D3 and D4 with supply reps?

Thank you for the compliments, but this is definitely where you overestimate me, and the area where I skimped the most. I attended attorney/accountant seminars offered by my dental school about job searches, contract negotiations, key phrases/components to make sure are included, things to watch out for, etc. I mostly took that information and flew solo. I am probably too much of a "gut" guy for my own good. Even though I think I'm in a pretty okay situation for a first position out of school, were I to do it again I would probably get some more outside help.

Basically the owner and I sat down and I explained the things that were most important to me and vice versa. Terms and numbers were agreed upon and the contract was drafted. I do not have a non-compete clause of any kind.

I did work with a guy from Henry Schein who was a rep at my school and had his fingers on the pulse. Tremendous resource.

And I met with an insurance expert and a financial planner several times to lay the groundwork for that department.

 

[ysrebob]

You're off to a great start, OP. This is the way associateships are supposed to look: mutually beneficial to you and your employer, with a sincere interest on their part in your clinical growth, and the opportunity to actually buy in as an owner and colleague down the road (not just the illusion of buying an illiquid minority stake offered by some corps). Helps greatly to be willing to look at positions in the exurbs/small towns. It would be quite difficult to find this a job of this quality in more urban areas. Two thumbs up.

 

[Medin2017]

Would you say you are an outlier in comparison to your peers?

Do you do any community service trips as a dentist?

If you could rewind the years back to dental school, knowing what you know now, what would you change?

 

[italianstallion2008]

Would you say you are an outlier in comparison to your peers?

Do you do any community service trips as a dentist?

If you could rewind the years back to dental school, knowing what you know now, what would you change?

Not too many people in my graduating class were overly vocal about the details of their contracts. A lot of them went into residency/GPR. So I can't say with too much confidence how I'd rate my situation in comparison to others. I know this was the most competitive of other opportunities I personally was evaluating, and I do feel like it is generally more appealing than what I was seeing from most dental corporations.

I've only been practicing for 2 months so I have not yet done any service trips, but in time I really look forward to the opportunity to volunteer in that fashion.

If I could go back in time I think I would have taken some kind of sculpting or ceramics class in undergrad. Something to develop handskills more. I work on cars a lot so I'm pretty good at turning wrenches, but the arts is something I could see being beneficial at the start of dental school.

In dental school I would have spent more time shadowing in graduate prosthodontics and learned as much as I possibly could from them about complex treatment planning. Dental school prepares you pretty well for single tooth dentistry, but piecing together a complex treatment plan on a geriatric patient with a collapsed VDO and cancer is on a whole new level. That is probably the area where I am seeking out the most guidance now from my boss and places like dental town. Complex case management. I would also say to remind myself not to be bashful at all about jumping in and trying to learn something new. Don't be the guy in the group letting somebody else volunteer first for a cool or challenging case. Just dive into the deep end. No better place to drown than in dental school with a bunch of faculty around to help you. Let them do their job by teaching you.

Also, I know there are mixed opinions on this, but I am in the corner of doing your very best academically in dental school. I understand that if you have no interest in specializing it really doesn't make a lot of difference what grades you get. But I didn't think I wanted to either, until all of the sudden I thought I did. How grateful I was to have had the freedom to have options. I got pretty good grades, and when the time came for me to make big career decisions, I had options. Deciding to be a GP didn't make me feel at all like I had wasted my time trying my best. And on top of that, the surprise $100k in scholarships for trying hard was an okay reward too. Some of my classmates in similar family situations as me graduated with $350-400k+ debt. I consider myself very very fortunate that our situation is a little different than that. Dental school is a grind. There were super awesome days and there were days when I wanted to stick an elevator in my eye socket. Just going back and reminding yourself from time to time that one day it will be over and you'll be so proud of what you've achieved and what that achievement has now given you the opportunity to do for yourself and others goes a long way.

 

[Medin2017]

T

Not too many people in my graduating class were overly vocal about the details of their contracts. A lot of them went into residency/GPR. So I can't say with too much confidence how I'd rate my situation in comparison to others. I know this was the most competitive of other opportunities I personally was evaluating, and I do feel like it is generally more appealing than what I was seeing from most dental corporations.

I've only been practicing for 2 months so I have not yet done any service trips, but in time I really look forward to the opportunity to volunteer in that fashion.

If I could go back in time I think I would have taken some kind of sculpting or ceramics class in undergrad. Something to develop handskills more. I work on cars a lot so I'm pretty good at turning wrenches, but the arts is something I could see being beneficial at the start of dental school.

In dental school I would have spent more time shadowing in graduate prosthodontics and learned as much as I possibly could from them about complex treatment planning. Dental school prepares you pretty well for single tooth dentistry, but piecing together a complex treatment plan on a geriatric patient with a collapsed VDO and cancer is on a whole new level. That is probably the area where I am seeking out the most guidance now from my boss and places like dental town. Complex case management. I would also say to remind myself not to be bashful at all about jumping in and trying to learn something new. Don't be the guy in the group letting somebody else volunteer first for a cool or challenging case. Just dive into the deep end. No better place to drown than in dental school with a bunch of faculty around to help you. Let them do their job by teaching you.

Also, I know there are mixed opinions on this, but I am in the corner of doing your very best academically in dental school. I understand that if you have no interest in specializing it really doesn't make a lot of difference what grades you get. But I didn't think I wanted to either, until all of the sudden I thought I did. How grateful I was to have had the freedom to have options. I got pretty good grades, and when the time came for me to make big career decisions, I had options. Deciding to be a GP didn't make me feel at all like I had wasted my time trying my best. And on top of that, the surprise $100k in scholarships for trying hard was an okay reward too. Some of my classmates in similar family situations as me graduated with $350-400k+ debt. I consider myself very very fortunate that our situation is a little different than that. Dental school is a grind. There were super awesome days and there were days when I wanted to stick an elevator in my eye socket. Just going back and reminding yourself from time to time that one day it will be over and you'll be so proud of what you've achieved and what that achievement has now given you the opportunity to do for yourself and others goes a long way.

This is a phenomenal reply. Thank you.

 

[free99]

I'm paid $600 if I produce less than $2000 on a given day. Once I exceed $2000 production, instead of being paid $600, I'm paid 0.3 x my production. Today for example my production was $4,813, so my take home was 0.3 x $4,813 or $1,444.

Can't recall what my best day has been off the top of my head.

I've worked 37 days so far with a YTD of $34,348.

Thanks for all the info. What kind of mix of procedures did you do on a day where you produce $4k+ of dentistry?

 

[italianstallion2008]

Thanks for all the info. What kind of mix of procedures did you do on a day where you produce $4k+ of dentistry?

Typically a full-ish restorative day and any one or more of the following:

2+ crowns
Patient commits to Invisalign
Extractions w/socket preservation for implant, extractions and immediate denture, implant restore, things of that nature.

 

[italianstallion2008]

Hey everyone.

I have been working for a little less than 6 months now as an associate in my practice, and I thought I would just check in and provide a couple of updates on my experience.

For the last several months I have been the primary doctor in the office, morning Monday - Friday from 8 - 4. The owner of the practice works on Tuesday and Wednesday only. Mostly 6-13 patients a day plus hygiene exams.

What a difference just a few months has made in terms of clinical competence and efficiency with respect to restorative dentistry. I have taken a couple of CE courses centered around composite technique. Combined with repitition I feel like I am making great strides both in quality and speed. Still a long way to go. I have been getting a lot of practice doing surgical extractions and am slowly developing a feel for when to refer to OMFS while gradually expanding my comfort zone.

My personal learning style has led me to benefiting greatly from the days the owner is not in the office. It's very much sink or swim in that all the patients and staff are looking to me for answers. Having my feet to the flame per se has been cause for a lot of great learning. The owner is really great about inviting me to expand my horizons and try new things especially on the days he is here, which I really appreciate.

I have placed an implant but have restored far more than I have placed. In my demographic there do not seem to be a lot of takers for implants, but I'm sure that as I take more CE my confidence in treatment planning them will grow. If you build it they will come.

My income to this point: $99,085 gross. I am still paid a daily minimum or 30% production, whichever is greater.

Another week and a half will put me at 6 months. In that time I have either taken off for personal reasons or CE or the office been closed for holidays/inclement weather for a total of 15 days.

I opened a Roth IRA for my wife and I and have contributed a little under $10k to it. We also have an emergency fund of $14k and change in a Capital One Money Market which returns 2%. All of that has been saved since I started working.

Currently evaluating health insurance options for next year. Probably going to do a HDHP to take advantage of an HSA and the tax benefits that provides, but I will keep you posted.

Student loan repayment officially begins at the end of December, but we've been paying on that early.

The big development recently is that my owner due to a family situation is going to be moving out of state in Jamuary. For one, I will be the lone doctor in the office on a permanent basis. Secondly, he has offered me the opportunity to purchase initially 50% of his practice here. I am beginning the process of evaluating this opportunity to determine if I want to do so.

As always I welcome any and all questions. I try to be as honest and open about my experience as I can be. Dentistry is by no means my passion in life, but I am really grateful for the quality of life I enjoy even in these early stages of my career. It takes me about 5 minutes to get home from work, and when I do I'm able to spend the rest of the day enjoying my wife and two kiddos (we had a baby boy in October!). I leave work at the office abd don't carry the burdens of the day with me. My wife says that I am far less stressed than I was in dental school and that she's happy I'm able to make so much time for my family. So in that sense and among other reasons I feel very blessed to enjoy the blessings that I do.

 

[desertrat12]

Thanks for doing this. These are very valuable for us dental students. I wish more people took the time. I see much more of this happening in medical specialties than dentists. Also congratulations on the success!

Are you happy you chose not to specialize?
If you stay at this practice, how do you see your income changing in the next year?
What is your opinion on the growth of corporate/dso practices, and have they had any impact on you?

 

[doktorinprogres]

I appreciate greatly that you're willing to talk real dollars and timelines to give us some sense of realism. That along with an understanding of the commensurate procedural mix early on makes your posts invaluable.

 

[coldicecream]

Do you think by easing into the practice and working alongside the current owner, it lowered your stress of "what if the patients don't stay when I buy the practice"?

 

[almostdoctortk]

any advice for a first year dental school student?

Sent from my ONEPLUS A5010 using SDN mobile

 

[tooth knockn]

I remember coming to this website time and time again in the early days of dental school. I wanted to take the opportunity to pop in and offer my willingness to share some of the early returns since I finished dental school and started practicing.

I graduated dental school in May 2018 and started working soon after. I gave a lot of thought to pedo while in dental school but ultimately decided against specializing immediately and entered general practice as an associate.

I practice in a rural community 30 minutes outside of a metropolitan area of about 1.5 million people.

I work M-F from 8-4pm seeing about 6-8 patients a day plus hygiene. I am compensated at a daily rate of $600/day or 30% production, whichever is higher. All lab costs are paid by the owner. After 1 year I will have an opportunity for a buy-in.

That should get things rolling. Ask me anything! And thanks again to all those who came before me.

Thank You Great Thread

WILL FOLLOW

 

[Pearl E. White]

Following. Great read. I hope to be as successful as you, OP.

 

[italianstallion2008]

Thanks for doing this. These are very valuable for us dental students. I wish more people took the time. I see much more of this happening in medical specialties than dentists. Also congratulations on the success!

Are you happy you chose not to specialize?
If you stay at this practice, how do you see your income changing in the next year?
What is your opinion on the growth of corporate/dso practices, and have they had any impact on you?

Sorry that it's taken a while for me to get back on the thread. New baby boy getting lots of attention.

At this juncture I am very happy with my decision not to specialize. I enjoy general dentistry and the variety it provides to my day. I get to dabble in quite a bit. I'm pretty social with my patients and get to enjoy the relationahips with patients that is more readily built in a general practice. I also encounter patients that I am glad to be able to refer. I look forward to gradually expanding my breadth of procedures, but I personally don't really see the day for myself where I'm keeping absolutely everything in house. I think some particular cases deserve the expertise, efficiency, and tech that specialists can provide, and frankly other cases just aren't necessarily worth (to me) the headache. I'm a big quality of life guy. Grateful for the specialists out there. Especially here where they are gracious enough to help me grow my own skills too. I have a great relationship with my OMFS and Ortho guys. They welcome me in their practices to learn techniques and always emphasize that they're just a phone call away.

The owner and I are discussing buy-in scenarios now. With the practice's current revenue, at a 50% buy-in my share of profits after servicing the business loan would be about $75,000 additional income annually plus an increase in production % for my individual salary. Negotiating that % now but headed toward raising from 30% now to 35% most likely. Plus tax benefits of switching from W-2 to owner. Plus more speed, skill, and patients.

There are no corporate or DSO practices in my region so I cannot really knowledgeably comment on their impact on my practice.

 

[italianstallion2008]

Do you think by easing into the practice and working alongside the current owner, it lowered your stress of "what if the patients don't stay when I buy the practice"?

That is never something that was overly concerning to me. I'm fairly confident in my own shoes and feel like I have an agreeable personality. I get along really well with kids and the older folks. Not trying to come across as arrogant by any means, but I have just always felt that bedside manner was my greatest aptitude as a health care provider. So I always figuered wherever I ended up I could win patients over and the ones who left probably weren't all that great to begin with.

I've seen it first hand in this practice. My first week was essentially the previous owners last. Over the last 6 months most patients have been willing to give us a try. We let a couple long time employees go and brought in a couple new faces. Patients are a little surprised for the first 5 minutes, but when you treat them well and keep them comfortable they come around just fine. I'm sure some patients have left, but many many have commented about how much happier they are with the transition. And our Google reviews reflect that.

A huge reason I wanted to associate first was because I wanted to "date" the practice and the area we've chosen to live before going all in. I always felt a little sacrifice in income on the front end would be small potatoes in the grand scheme of things. Making sure me, MY WIFE! and my family could be happy in our new practice and community was more important to me. And I really have learned a ton clinically and professionally in this time with zero stress of ownership. To everything there is a season. All in good time. Money isn't everything.

 

[italianstallion2008]

Following. Great read. I hope to be as successful as you, OP.

 

[coldicecream]

That is never something that was overly concerning to me. I'm fairly confident in my own shoes and feel like I have an agreeable personality. I get along really well with kids and the older folks. Not trying to come across as arrogant by any means, but I have just always felt that bedside manner was my greatest aptitude as a health care provider. So I always figuered wherever I ended up I could win patients over and the ones who left probably weren't all that great to begin with.

I've seen it first hand in this practice. My first week was essentially the previous owners last. Over the last 6 months most patients have been willing to give us a try. We let a couple long time employees go and brought in a couple new faces. Patients are a little surprised for the first 5 minutes, but when you treat them well and keep them comfortable they come around just fine. I'm sure some patients have left, but many many have commented about how much happier they are with the transition. And our Google reviews reflect that.

A huge reason I wanted to associate first was because I wanted to "date" the practice and the area we've chosen to live before going all in. I always felt a little sacrifice in income on the front end would be small potatoes in the grand scheme of things. Making sure me, MY WIFE! and my family could be happy in our new practice and community was more important to me. And I really have learned a ton clinically and professionally in this time with zero stress of ownership. To everything there is a season. All in good time. Money isn't everything.

thanks for replying!
might do the same as you or work as an associate for 2 yrs, save up for a loan and start my own practice. I think you got really lucky to find that owner.
do you know what the overhead is like? I'm looking at some practices being sold and can't believe they have overheads of 70%.

 

[doktorinprogres]

thanks for replying!
might do the same as you or work as an associate for 2 yrs, save up for a loan and start my own practice. I think you got really lucky to find that owner.
do you know what the overhead is like? I'm looking at some practices being sold and can't believe they have overheads of 70%.

How well versed are you in practice financials? The reason I ask is b/c after reading through a bunch of different practices 70 doesn't really faze me anymore.
Typically if it's an older dentist s/he's been pretty relaxed production wise and has raised salaries to the point its pretty generous in comparison to market rates. If you produce more your expenses become a smaller percentage b/c fixed costs dont change. In addition, you can vet your staff and let the overpaid ones go or tell them you're dropping their salary. Dropping salary is usually a cause of said staff hitting the door on their own. Be careful about employment laws though and make sure you CYA.

Keep in mind that a super great practice with below average overhead is going to be hard to find (who's gonna sell a goldmine) or priced unfavorably high.

 

[coldicecream]

How well versed are you in practice financials? The reason I ask is b/c after reading through a bunch of different practices 70 doesn't really faze me anymore.
Typically if it's an older dentist he's been pretty relaxed production wise and has raised salaries to the point its pretty generous in comparison to market rates. If you produce more your expenses become a smaller percentage b/c fixed costs dont change. In addition, you can vet your staff and let the overpaid ones go or tell them you're dropping their salary. Dropping salary is usually a cause of said staff hitting the door on their own. Be careful about employment laws though and make sure you CYA.

Keep in mind that a super great practice with below average overhead is going to be hard to find (who's gonna sell a goldmine) or priced unfavorably high.

still learning practice financials, but i do know the general financial statements pretty well. When i see these high overheads, in general businesses, no one would want to touch them. too much work to fix, but I see how in dentistry, it's not too difficult to fix.

 

[doktorinprogres]

still learning practice financials, but i do know the general financial statements pretty well. When i see these high overheads, in general businesses, no one would want to touch them. too much work to fix, but I see how in dentistry, it's not too difficult to fix.

Can I ask if you have any good reads for disecting financial statements? It's kind of curious you say that b/c theoretically dentistry has really favorable business margins. My understanding is that's the reason private equity money is being funneled towards corporate dentistry.

 

[coldicecream]

Can I ask if you have any good reads for disecting financial statements? It's kind of curious you say that b/c theoretically dentistry has really favorable business margins. My understanding is that's the reason private equity money is being funneled towards corporate dentistry.

i'm a business major so they just teach us how to read them, evaluate a business (usually large corps) through different ratios. sorry, don't really have specifics reads.

i also assumed dentistry would have favorable business margins after shadowing and doing mental math of the dentists production along with checking out the costs of supplies. I was just shocked to see how some practices are being sold but have horrible margins. This could be tunnel vision though since successful practices wouldn't put "For Sale" ads if they are doing well lol

I still have some reading to do myself on business in dentistry, but I wouldn't be surprised in private equity is being put into corporate dentistry. In the past five years, I've seen so many of those pop up.

 

[doktorinprogres]

i'm a business major so they just teach us how to read them, evaluate a business (usually large corps) through different ratios. sorry, don't really have specifics reads.

i also assumed dentistry would have favorable business margins after shadowing and doing mental math of the dentists production along with checking out the costs of supplies. I was just shocked to see how some practices are being sold but have horrible margins. This could be tunnel vision though since successful practices wouldn't put "For Sale" ads if they are doing well lol

I still have some reading to do myself on business in dentistry, but I wouldn't be surprised in private equity is being put into corporate dentistry. In the past five years, I've seen so many of those pop up.

I'm jealous, being a business major is going to give you a decent leg up in terms of really understanding that side of dentistry.