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ROAD Specialties vs Dentistry

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I'm not sure if this is the right forum, but I wanted to learn some more on the ROAD specialties. Currently in undergrad and a pre-dent, but I just wanna explore my options and see how green the grass is on the other side.

I was going for dentistry due to the autonomy, business opportunities and relaxed lifestyle. I've shadowed a very successful dentist and honestly the life seems great, he doesn't seem overworked even though his practice is very busy etc. I started researching medical fields to see if similar experiences can be achieved in certain medical specialties, and I came across the ROAD specialties.

Can someone give me more insight on what the ROAD specialties are like. Are there as many entrepreneurial opportunities in these specialties as there are in dentistry (i.e. opening up multiple entrepreneurial satellite practices and running the group as a corporation for passive income) and how is the autonomy/lifestyle of the profession. Obviously the ROAD specialties are known for their more relaxed lifestyle, but I wonder if you can set your own hours, do as you wish, take a vacation whenever you want etc. as compared to other specialties.

Not sure if it matters, but I'm indifferent about prestige, and I don't really care if I look at teeth or buttcracks all day long haha. I also don't care for a war about medicine vs dentistry, I'm just looking for an objective way to compare the two career paths ROAD vs Dentistry so I can make a more informed decision about my future.

Thanks
 

gyngyn

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Given your interests, I recommend dentistry.
If you get into dental school, you can be a dentist.
Even if you get into medical school, there is no way to predict if you will match into your preferred specialty.
 
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Given your interests, I recommend dentistry.
If you get into dental school, you can be a dentist.
Even if you get into medical school, there is no way to predict if you will match into your preferred specialty.

Is getting into the ROAD specialties really that difficult. From what I've seen the match rates don't seem too bad. Maybe I'm misinterpreting the charts though.

Either way, I'm a pretty good test taker, so I feel like I could get strong test scores which should give me many options should I choose medicine.
You are right though, if I were forced into a specialty I don't like, that would make my life rather miserable.
 

gyngyn

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Is getting into the ROAD specialties really that difficult. From what I've seen the match rates don't seem too bad. Maybe I'm misinterpreting the charts though.

Either way, I'm a pretty good test taker, so I feel like I could get strong test scores which should give me many options should I choose medicine.
You are right though, if I were forced into a specialty I don't like, that would make my life rather miserable.
The difficulty of matching in any specialty can change dramatically in a short period.
Radiology, anesthesia and psych have been both accessible and challenging within a short time-frame.
Ophthalmology and derm have been quite difficult for a long time.
None of these is particularly entrepreneurial and the education and training are much longer in duration.
It's not all about the test, either. Plenty of high stats applicants don't match when a particular field becomes popular.
 
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Min:))

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Lifestyle can pretty much be cultivated into anything you do (including some specialties in medicine....eventually after years of hard work), but it is definitely easier to do so in dentistry. I shadowed both dentists and doctors; while I did enjoy the work of dentists, I felt that medicine was definitely for me. Some believe it's a "calling"... after you shadow and talk to people in both professions, you'll see, sooner or later, where your interests truly lie. So...go shadow and talk to doctors in a lot of different specialties!!
 
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Lucca

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IMO one should not go to medical school with the singular aim of landing only ROAD. Dentistry provides you with a much straighter, broader path to the goals you set for yourself in the OP.
 
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Goro

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I'm not sure if this is the right forum, but I wanted to learn some more on the ROAD specialties. Currently in undergrad and a pre-dent, but I just wanna explore my options and see how green the grass is on the other side.

I was going for dentistry due to the autonomy, business opportunities and relaxed lifestyle. I've shadowed a very successful dentist and honestly the life seems great, he doesn't seem overworked even though his practice is very busy etc. I started researching medical fields to see if similar experiences can be achieved in certain medical specialties, and I came across the ROAD specialties.

Can someone give me more insight on what the ROAD specialties are like. Are there as many entrepreneurial opportunities in these specialties as there are in dentistry (i.e. opening up multiple entrepreneurial satellite practices and running the group as a corporation for passive income) and how is the autonomy/lifestyle of the profession. Obviously the ROAD specialties are known for their more relaxed lifestyle, but I wonder if you can set your own hours, do as you wish, take a vacation whenever you want etc. as compared to other specialties.

Not sure if it matters, but I'm indifferent about prestige, and I don't really care if I look at teeth or buttcracks all day long haha. I also don't care for a war about medicine vs dentistry, I'm just looking for an objective way to compare the two career paths ROAD vs Dentistry so I can make a more informed decision about my future.

Thanks
First get into med school, then worry about specialties.
 
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IMO one should not go to medical school with the singular aim of landing only ROAD. Dentistry provides you with a much straighter, broader path to the goals you set for yourself in the OP.
First get into med school, then worry about specialties.

See the issue I have with this is that this makes it seem like I cannot dictate my future if I do decide to attend medical school. Shouldn't it be normal to be specific about which specialty you want to get into? I can't imagine getting put into a random specialty I dislike after going through 8 years of tough schooling, that sounds miserable. If you go into medical school like a chicken with its head cut off, you will be in for a rude awakening when you actually start practicing. That's probably why some doctors burnout. It seems counter-intuitive to work so hard to get into medical school, and then not be worried about what your actual profession. There's a monumental difference between neurosurgery and primary care, sure they are all doctors but the actual work entails two completely different things.
 

Goro

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See the issue I have with this is that this makes it seem like I cannot dictate my future if I do decide to attend medical school. Shouldn't it be normal to be specific about which specialty you want to get into? I can't imagine getting put into a random specialty I dislike after going through 8 years of tough schooling, that sounds miserable. If you go into medical school like a chicken with its head cut off, you will be in for a rude awakening when you actually start practicing. That's probably why some doctors burnout. It seems counter-intuitive to work so hard to get into medical school, and then not be worried about what your actual profession. There's a monumental difference between neurosurgery and primary care, sure they are all doctors but the actual work entails two completely different things.
Being a novice in the medical education process, it's clear that you're unaware that tons of med students change their minds about what they want to specialize in, especially once they hit the reality of rotations.

This is especially true for people who have never shadowed in the fields they're so interested in, or who have only shadowed only in what they're focused on.

But first, you have to get into med school. 60% of all applicants never do.
 
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When I went into med school, I had the same mentality and was pretty much only interested in ROAD... I worked hard and also got lucky enough to match derm, but let me tell you, this is the wrong mentality. I had so many classmates who were also trying to get into ROAD and they did not get in and were super disappointed... not to say that other specialties suck, they don't, but if you are dead set on ROAD and don't match, it will be disappointing. wrt your concerns about autonomy, it is pretty solid in optho and derm depending on location and market saturation, anesthesia and rads it is a little harder i think. If you are open minded and ready to work like a dog to get what you want, I would recommend med school, if you are 100% deadset on something lifestyle related and don't care too much about comp, I would go dentistry. not to compare med to dentistry, but matching into something like optho or derm is probably 50 times harder than getting into dental school, so you have to be ready and willing to do the work
 
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gyngyn

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not to compare med to dentistry, but matching into something like optho or derm is probably 50 times harder than getting into dental school, so you have to be ready and willing to do the work
And be ready to face the fact that doing the work may not be enough.
 
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Lucca

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See the issue I have with this is that this makes it seem like I cannot dictate my future if I do decide to attend medical school. Shouldn't it be normal to be specific about which specialty you want to get into? I can't imagine getting put into a random specialty I dislike after going through 8 years of tough schooling, that sounds miserable. If you go into medical school like a chicken with its head cut off, you will be in for a rude awakening when you actually start practicing. That's probably why some doctors burnout. It seems counter-intuitive to work so hard to get into medical school, and then not be worried about what your actual profession. There's a monumental difference between neurosurgery and primary care, sure they are all doctors but the actual work entails two completely different things.

It’s true that people tend to sort themselves in med school into very different sorts of work. It’s also true that there are large archetypal “types” that people can fall into - surgery vs. medicine for example. However, there are absolutely zero guarantees in medicine and you have to be comfortable with the fact that you may need to curb your expectations, desires, and goals to conform to your personal reality. For that reason, I don’t think one should go to medical school with a singular hypercompetitive career in mind. This, of course, does not mean that everyone follows this standard. Some people go in with an idea in mind from day 1 and leave on graduation day on exactly the same path they started on. Others leave clinical medicine entirely after earning the MD because they realized in medical school that they couldn’t see themselves in any of the options that were given to them. This isn’t an ideal position to be in, though, and one should avoid it. Read every other thread on the Allo forum the week Step scores are released to confirm this for yourself.

If this seems absurd to you, then the solution is simple: don’t go to medical school.
 
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LebronManning

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This isn't the correct way to make the decision of physician vs. dentist because both can make a business out of themselves. The dental route is simply an easier way to get there but you sacrifice career prestige (if you care about that) and the ability to practice interesting parts of medicine/physiology (sorry but I don't think anyone thinks teeth are actually interesting - I'm biased). In fact the main difference is that in dentistry, you are FORCED to be an entrepreneur to make decent money while most MDs who work for others still make more money than dentist entrepreneurs.

You can do anything you would do as an entrepreneurial dentist as a entrepreneurial physician. In fact, better. Demand for physicians will ALWAYS be much higher than dentists. And this is NOT limited to the ROAD specialties. I know plenty of primary care physicians and pediatricians in my area making millions due to satellite offices and what not. My middle school buddy's uncle is a dermatologist in the area who started 30 years ago and now has 10-12 satellite offices (surely making a few million per year). In anesthesia, work will always be hospital (or outpatient surgery center) based so the odds of owning your practice are low, but there's a recent trend in favor of massive anesthesia staffing companies - who's to say you couldn't start and run one of those?

TL;DR: You can't make this decision based on whether you will match rOaD (Ophtho and Derm are really the competitive ones) vs. Dentistry. It has to be physician vs dentistry. But rest assured, you can be just as much of an entrepreneur in both fields.
 
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This isn't the correct way to make the decision of physician vs. dentist because both can make a business out of themselves. The dental route is simply an easier way to get there but you sacrifice career prestige (if you care about that) and the ability to practice interesting parts of medicine/physiology (sorry but I don't think anyone thinks teeth are actually interesting - I'm biased). In fact the main difference is that in dentistry, you are FORCED to be an entrepreneur to make decent money while most MDs who work for others still make more money than dentist entrepreneurs.

You can do anything you would do as an entrepreneurial dentist as a entrepreneurial physician. In fact, better. Demand for physicians will ALWAYS be much higher than dentists. And this is NOT limited to the ROAD specialties. I know plenty of primary care physicians and pediatricians in my area making millions due to satellite offices and what not. My middle school buddy's uncle is a dermatologist in the area who started 30 years ago and now has 10-12 satellite offices (surely making a few million per year). In anesthesia, work will always be hospital (or outpatient surgery center) based so the odds of owning your practice are low, but there's a recent trend in favor of massive anesthesia staffing companies - who's to say you couldn't start and run one of those?

TL;DR: You can't make this decision based on whether you will match rOaD (Ophtho and Derm are really the competitive ones) vs. Dentistry. It has to be physician vs dentistry. But rest assured, you can be just as much of an entrepreneur in both fields.

Wow, this just made me a lot more excited about medicine. I don't mind the entrepreneurship at all, in fact that is exactly what I'm looking for. Ideally by mid career I wouldn't be practicing medicine at all and would just be a CEO of my corporation.

How competitive would you say the corporate landscape is in medicine? It it easier or more difficult to branch out and form a corporate entity in a medical setting than a dental setting? Theoretically, what would be an achievable rate of practice acquisitions in medicine? 1 practice a year? 2 per year? Are there any regulations placed by the government etc.?

I had primarily thought that only ROAD specialties could go this route because I assumed most other specialties are stuck working in a hospital for some higher corporate entity. But you've opened my eyes to what's possible with other specialties as well.
 

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I don’t know how you all can deal with this day in and day out. I am not sure if I should feel excited or ashamed of op. I guess I am in that generation who is getting old.

I hope you’re as brilliant as you think you are, op. I am awaiting for you to report back in 2 years, when you get in med school, 4 years when you graduate on time and had chosen a speciality. Another 4-7 years when you done with your residency/fellowship. After that another 5-10 year when you’re CEO of your company.

Good luck.
 
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LebronManning

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Wow, this just made me a lot more excited about medicine. I don't mind the entrepreneurship at all, in fact that is exactly what I'm looking for. Ideally by mid career I wouldn't be practicing medicine at all and would just be a CEO of my corporation.

How competitive would you say the corporate landscape is in medicine? It it easier or more difficult to branch out and form a corporate entity in a medical setting than a dental setting? Theoretically, what would be an achievable rate of practice acquisitions in medicine? 1 practice a year? 2 per year? Are there any regulations placed by the government etc.?

I had primarily thought that only ROAD specialties could go this route because I assumed most other specialties are stuck working in a hospital for some higher corporate entity. But you've opened my eyes to what's possible with other specialties as well.

This is going to sound bad but the corporate/entrepreneurship landscape is probably the least competitive in medicine compared to all other businesses. The reason being the MD degree is a huge barrier shutting out most Americans. Put that together with the fact that most MDs don’t become physicians to run a business but rather to practice medicine, and you’ve got less of a competitive landscape than you’d think. The most important point though is supply and demand; huge physician shortage now and into the future. Starting a practice in medicine will almost always succeed. Recently had a family friend who started a Family Practice and he is up to 450K in year 3; that’s ok for him and doesn’t want to expand. Basically practices will always succeed, but if you want to expand it to 15 satellite offices grossing 5 Mil you’ll need some business acumen to do that. It can and has been done though.

There really isn’t anything about ROAD specialties that makes this more possible. Only difference is that your profit margins per patient with probably be higher with derm and ophtho than primary care. The flip side of that is that it’s probably easier to build a mega practice with multiple satellite offices in primary care because of the HUUGE primary care physician shortage. There’s actually more competition in the specialties.

Also remember becoming a primary care physician (Peds, FM, or Internist) requires only 3 years of residency for which you get paid. In dentistry, if you want to do orthodontics or Perio, you spend the same time in residency and often have to PAY 50-60k for residency vs in the MD route you get paid that much.

Being a physician is still prestigious and profitable if you know how to do it right. Same with dentistry but perhaps less so generally.

Ultimately though you can’t know this is the route you want to pursue. Growing up in a physician household, I originally was averse to becoming a physician. I grew warmer to it because of these ideas to run businesses. Interestingly though as I’ve gained more clinical experience and been accepted to medical school, I am actually starting to become more interested in actually pathophgsiology. You know what’s cooler than making a million through business? Making a million through interventional cardiology, neurosurgery, orthopedics, plastic surgey, gastroenterology, etc. In fields like those, you basically run your services as a business and can still make 7 figures because of how important your procedures are and are thus compensated that way. This way, you also change and save lives which is priceless.

The point is being a physician is what you make out of it and that’s my favorite part of the field.
 
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IMGASMD

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This is going to sound bad but the corporate/entrepreneurship landscape is probably the least competitive in medicine compared to all other businesses. The reason being the MD degree is a huge barrier shutting out most Americans. Put that together with the fact that most MDs don’t become physicians to run a business but rather to practice medicine, and you’ve got less of a competitive landscape than you’d think. The most important point though is supply and demand; huge physician shortage now and into the future. Starting a practice in medicine will almost always succeed. Recently had a family friend who started a Family Practice and he is up to 450K in year 3; that’s ok for him and doesn’t want to expand. Basically practices will always succeed, but if you want to expand it to 15 satellite offices grossing 5 Mil you’ll need some business acumen to do that. It can and has been done though.

There really isn’t anything about ROAD specialties that makes this more possible. Only difference is that your profit margins per patient with probably be higher with derm and ophtho than primary care. The flip side of that is that it’s probably easier to build a mega practice with multiple satellite offices in primary care because of the HUUGE primary care physician shortage. There’s actually more competition in the specialties.

Also remember becoming a primary care physician (Peds, FM, or Internist) requires only 3 years of residency for which you get paid. In dentistry, if you want to do orthodontics or Perio, you spend the same time in residency and often have to PAY 50-60k for residency vs in the MD route you get paid that much.

Being a physician is still prestigious and profitable if you know how to do it right. Same with dentistry but perhaps less so generally.

Ultimately though you can’t know this is the route you want to pursue. Growing up in a physician household, I originally was averse to becoming a physician. I grew warmer to it because of these ideas to run businesses. Interestingly though as I’ve gained more clinical experience and been accepted to medical school, I am actually starting to become more interested in actually pathophgsiology. You know what’s cooler than making a million through business? Making a million through interventional cardiology, neurosurgery, orthopedics, plastic surgey, gastroenterology, etc. In fields like those, you basically run your services as a business and can still make 7 figures because of how important your procedures are and are thus compensated that way. This way, you also change and save lives which is priceless.

The point is being a physician is what you make out of it and that’s my favorite part of the field.

I don’t necessarily disagree. But i also want you and OP to realize that when you make 5mil a year, you’re most likely built that on top of your colleagues/employees. Maybe nothing wrong with that and that’s how our system works.

when you realize, there is no way both serve the patients and make “that kind of money”, without screw someone over your perspective may change. There is limited money in the system, unless you only take cash, there really isn’t a way to extract that kind of money from the system. For primary care, insurance company may have some kind of cap on what they are welling to pay every year. At some point you can only see so many patients and you can only cap out at so much money.

Let’s say you’re the owner of a primary care practice, and no matter how much you work, your cap is 1 million dollars, which is a lot of money, but nowhere near that 5 million that you want to make. So you hire 10 doctors, you make them do 1 million dollar worth of work. You only pay them 400k for their work. And pocket the 600k. So now you you make 6 mil, and say I don’t need to work anymore. However in a few years, your colleagues/employees say, it’s unfair why are you making money off my back. I want my full cool million. You say, oh fine, I will make some of you, my partners. But you no longer make cool 6 Mil. Then you say, I need to find someone, new grads, who don’t know any better and will work for 300k, so I can pocket 700k they are generating. Raise and repeat in a few years. And at some point the market is saturated. You can no longer expand or take on any partners. On the horizon, there is this big national company who will buy you out, and offer you lump sum of money. That’s your whole “career.”

This is the business side of medicine. Ta-da. No magic, just something no one will ever teach you in med school or even residency. Repeat after me, I will not get rich becoming a doctor. If that’s what you’re after, there are easier ways.
 
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LebronManning

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I don’t necessarily disagree. But i also want you and OP to realize that when you make 5mil a year, you’re most likely built that on top of your colleagues/employees. Maybe nothing wrong with that and that’s how our system works.

when you realize, there is no way both serve the patients and make “that kind of money”, without screw someone over your perspective may change. There is limited money in the system, unless you only take cash, there really isn’t a way to extract that kind of money from the system. For primary care, insurance company may have some kind of cap on what they are welling to pay every year. At some point you can only see so many patients and you can only cap out at so much money.

Let’s say you’re the owner of a primary care practice, and no matter how much you work, your cap is 1 million dollars, which is a lot of money, but nowhere near that 5 million that you want to make. So you hire 10 doctors, you make them do 1 million dollar worth of work. You only pay them 400k for their work. And pocket the 600k. So now you you make 6 mil, and say I don’t need to work anymore. However in a few years, your colleagues/employees say, it’s unfair why are you making money off my back. I want my full cool million. You say, oh fine, I will make some of you, my partners. But you no longer make cool 6 Mil. Then you say, I need to find someone, new grads, who don’t know any better and will work for 300k, so I can pocket 700k they are generating. Raise and repeat in a few years. And at some point the market is saturated. You can no longer expand or take on any partners. On the horizon, there is this big national company who will buy you out, and offer you lump sum of money. That’s your whole “career.”

This is the business side of medicine. Ta-da. No magic, just something no one will ever teach you in med school or even residency. Repeat after me, I will not get rich becoming a doctor. If that’s what you’re after, there are easier ways.

Agreed. No one will be making 5 mil based on their professional billings as a physician. Max is probably 2 mil in Ortho spine or Neurosurgery.

The way to make that 5 mil + is in fact on the back of other physicians and that is business. I don't think there's anything wrong with that. Some physicians will be better businessmen/women than others and they will reap the benefits. After all, this country was built on capitalism and that is what separates us from the socialist world. I disagree that in this case you are "screwing someone over" though. My dad worked for a Pulmonary/Hospitalist group in the area for 15 years. They only paid him 250-300K while the doc who started it was netting somewhere around 6 mil. It took that guy blood, sweat, and tears to build that group over 20 years and I think he deserved every penny of the 6 mil. My dad just wanted a quick 7 on 7 off hospitalist job where he could make 300k and so was happy.

I also think "you won't get rich being a doctor" is a lie and only perpetuated here because all docs are rich and so when you compare yourself to your peers you aren't rich. Any doc in this country that wants to can make 300K which in comparison to the rest of the country is not only rich, but LOADED. Then when you see some specialties making up to 7 figures, there is no doubt that medicine is a way to become rich. However, it may not be worth it if you don't have the desire to become a physician for the other more noble reasons in the first place.
 
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getdown

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I don’t necessarily disagree. But i also want you and OP to realize that when you make 5mil a year, you’re most likely built that on top of your colleagues/employees. Maybe nothing wrong with that and that’s how our system works.

when you realize, there is no way both serve the patients and make “that kind of money”, without screw someone over your perspective may change. There is limited money in the system, unless you only take cash, there really isn’t a way to extract that kind of money from the system. For primary care, insurance company may have some kind of cap on what they are welling to pay every year. At some point you can only see so many patients and you can only cap out at so much money.

Let’s say you’re the owner of a primary care practice, and no matter how much you work, your cap is 1 million dollars, which is a lot of money, but nowhere near that 5 million that you want to make. So you hire 10 doctors, you make them do 1 million dollar worth of work. You only pay them 400k for their work. And pocket the 600k. So now you you make 6 mil, and say I don’t need to work anymore. However in a few years, your colleagues/employees say, it’s unfair why are you making money off my back. I want my full cool million. You say, oh fine, I will make some of you, my partners. But you no longer make cool 6 Mil. Then you say, I need to find someone, new grads, who don’t know any better and will work for 300k, so I can pocket 700k they are generating. Raise and repeat in a few years. And at some point the market is saturated. You can no longer expand or take on any partners. On the horizon, there is this big national company who will buy you out, and offer you lump sum of money. That’s your whole “career.”

This is the business side of medicine. Ta-da. No magic, just something no one will ever teach you in med school or even residency. Repeat after me, I will not get rich becoming a doctor. If that’s what you’re after, there are easier ways.

@LebronManning Boom, this is the entire business models for AMCs (anesthesia management companies) that you suggested to OP start. This is currently the bane of existent of all providers in Anesthesia. Some company comes in and screws everyone out of what they should be making because their main goal is making a profit. Who cares about patient care if we can make that extra million dollars. Let's staff every room with CRNAs and then make the MDs cover 4 rooms and pay everyone a fraction of what they deserve. The whole model is a ****ing travesty. If you have no morals and want that bugatti and mansion in Santa Monica coast then go ahead and do this but let's not try to pass it as anything more than profit making scheme. Thankfully most hospitals are starting to wise up on this practice. If you want to learn more about this visit the Anesthesia forums. You'll see all the nasty shady **** that these so called "companies" do to make a profit.

Also, there's a difference between rich and wealthy. Chris Rock explained it best... NBA players are rich but the owners are wealthy. Just as doctors are rich but the hospital CEOs and CEOs of hospital chains are wealthy.
 
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IMGASMD

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Agreed. No one will be making 5 mil based on their professional billings as a physician. Max is probably 2 mil in Ortho spine or Neurosurgery.

The way to make that 5 mil + is in fact on the back of other physicians and that is business. I don't think there's anything wrong with that. Some physicians will be better businessmen/women than others and they will reap the benefits. After all, this country was built on capitalism and that is what separates us from the socialist world. I disagree that in this case you are "screwing someone over" though. My dad worked for a Pulmonary/Hospitalist group in the area for 15 years. They only paid him 250-300K while the doc who started it was netting somewhere around 6 mil. It took that guy blood, sweat, and tears to build that group over 20 years and I think he deserved every penny of the 6 mil. My dad just wanted a quick 7 on 7 off hospitalist job where he could make 300k and so was happy.

I also think "you won't get rich being a doctor" is a lie and only perpetuated here because all docs are rich and so when you compare yourself to your peers you aren't rich. Any doc in this country that wants to can make 300K which in comparison to the rest of the country is not only rich, but LOADED. Then when you see some specialties making up to 7 figures, there is no doubt that medicine is a way to become rich. However, it may not be worth it if you don't have the desire to become a physician for the other more noble reasons in the first place.

That’s what I said in my opening statement. There is nothing wrong, if it’s money you want to chase. And believe me, I of all people understand you cannot eat your morals or be fed by your statues in the community. I, however, concluded, there are much easier path to make money. Maybe I don’t like the idea, a bean counter who tells me that I haven’t worked hard enough. Or I have not billed enough. I don’t necessarily disavow partnerships in medicine. I personally just have not figured out, how can our society and our profession, extract anymore “value” from the medical system. Or the fact we have learned the take advantages of our own in the process.

I just caught kevinmd’s article on everyone believe “all doctors are rich” fallacy. Maybe you also read it.

PS. It’s not just anesthesia they’re after, Hospitalist, EM are also under siege. But that’s our reality.

PPS. For those who are interested. “A case for paying doctors more” is the article that I just read. Posted on Kevinmd.
 
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raiderette

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I went to an ob/gyn once that did all the regular, but also had people selling diet plans, Botox, herbal wraps attached to a Curves. It was a one-stop woman center. Freaked me out, but they made fistfuls of money. They still had one if the best MFM specialists in the area, so they weren't all hacks, but it was very consumer driven. Many specialties can do this.
 
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I don’t know how you all can deal with this day in and day out. I am not sure if I should feel excited or ashamed of op. I guess I am in that generation who is getting old.

I hope you’re as brilliant as you think you are, op. I am awaiting for you to report back in 2 years, when you get in med school, 4 years when you graduate on time and had chosen a speciality. Another 4-7 years when you done with your residency/fellowship. After that another 5-10 year when you’re CEO of your company.

Good luck.

Thank you sir. I haven't chosen the medical path yet, but if I do then that timeline seems like something I would want to follow. I know some might be ashamed of me for not looking at medicine the traditional way, but everyone is different. Most probably tend to put more focus on the actual practice of medicine, and others look at the entrepreneurial opportunities in medicine. I don't think you can go wrong with either.
 
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IMGASMD

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Thank you sir. I haven't chosen the medical path yet, but if I do then that timeline seems like something I would want to follow. I know some might be ashamed of me for not looking at medicine the traditional way, but everyone is different. Most probably tend to put more focus on the actual practice of medicine, and others look at the entrepreneurial opportunities in medicine. I don't think you can go wrong with either.

I am not ashamed of you, yet. :)
My point is, keep an open mind. There is no rainbow, no pot of gold at the end of the yellow brick road. If you’re interested in something else, be it money, fame, prestige, entrepreneurship..... look at somewhere else first? It’s a long road. If you’re only just looking for money, this may not be the easiest and most straight forward road. I do commend you for looking now, rather than five years from now. Also, you have the maturity to say it out loud, that money is important. (I just hope that isn’t everything.). A lot of your classmates in these forums may not have the foresight to admit that to people, or worse, themselves.

Good luck.
 
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@LebronManning Thank you for your insight. That was the exact type of business model I wanted to set up. Regardless on if I went into medicine or dentistry, I would create my own "group" where I can form partnerships with other doctors. I would assume first I would need to start with a solid profitable practice of my own before expanding, but once I can learn how to make a practice profitable, all I need to do is replicate that model into my satellite practices.

@IMGASMD I appreciate your insight as well. Everything you said is just about what I envision my future as. Some might find it morally wrong, but I can't please everybody. I want to form partnerships with other doctors where they also own stakes in the group, and they practice under my umbrella corporate entity. The exit strategy could be me selling my group to a bigger company and cashing out, but ideally I want my group to prosper to the highest ranks. Not sure if it's possible for a small group to become a corporate giant in the medical landscape, but in the dental landscape there are many examples of corporations exploding, such as Heartland Dental. Their CEO and founder is Rick Workman, who is a dentist who came from a small town and started off with one dental practice. Now he makes over 10 million a year easily. Anyone can make it, it just takes hard work, vision, and willingness to take risks. Even if I personally don't make it, atleast I can die peacefully knowing that I tried and gave it my best. You miss 100% of the shots you don't take. Regardless, I don't need to be filthy rich to be happy. I just want a comfortable life, where I work less and don't have to worry about money.

And sure, I can take other paths to wealth. Anyone smart enough to make it through med school is probably smart enough to become a successful investment banker for example, who can start earning 7 figures before an MD will even start practicing. But I prefer the healthcare setting along with entrepreneurship. I probably couldn't stand Wall Street.
 
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I am not ashamed of you, yet. :)
My point is, keep an open mind. There is no rainbow, no pot of gold at the end of the yellow brick road. If you’re interested in something else, be it money, fame, prestige, entrepreneurship..... look at somewhere else first? It’s a long road. If you’re only just looking for money, this may not be the easiest and most straight forward road. I do commend you for looking now, rather than five years from now. Also, you have the maturity to say it out loud, that money is important. (I just hope that isn’t everything.). A lot of your classmates in these forums may not have the foresight to admit that to people, or worse, themselves.

Good luck.

Yup I'm still exploring all my options. This thread has really given me great insight into the corporate side of the medical world as well. I know it may seem like I'm only in it for the money and building a cash cow business, but I gotta say my goal is to create a group which prides itself on practicing good medicine/dentistry. I actually despise a lot of the corporate dental practices where patients are "overtreated" just because the dentist has to meet a financial quota. I believe that if you are good at what you do, the money will come.
 
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Every medical student is really good at test taking, you won't be special

But every medical student is not equally good at test taking, otherwise everyone would have identical USMLE scores.

It doesn't really matter though, as I learned that even if you get perfect test scores, there's a chance you won't match where you want to match.
 

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I'm not sure if this is the right forum, but I wanted to learn some more on the ROAD specialties. Currently in undergrad and a pre-dent, but I just wanna explore my options and see how green the grass is on the other side.

I was going for dentistry due to the autonomy, business opportunities and relaxed lifestyle. I've shadowed a very successful dentist and honestly the life seems great, he doesn't seem overworked even though his practice is very busy etc. I started researching medical fields to see if similar experiences can be achieved in certain medical specialties, and I came across the ROAD specialties.

Can someone give me more insight on what the ROAD specialties are like. Are there as many entrepreneurial opportunities in these specialties as there are in dentistry (i.e. opening up multiple entrepreneurial satellite practices and running the group as a corporation for passive income) and how is the autonomy/lifestyle of the profession. Obviously the ROAD specialties are known for their more relaxed lifestyle, but I wonder if you can set your own hours, do as you wish, take a vacation whenever you want etc. as compared to other specialties.

Not sure if it matters, but I'm indifferent about prestige, and I don't really care if I look at teeth or buttcracks all day long haha. I also don't care for a war about medicine vs dentistry, I'm just looking for an objective way to compare the two career paths ROAD vs Dentistry so I can make a more informed decision about my future.

Thanks

If you can see yourself doing anything else other than medicine, you should ask yourself: do you really want to do medicine??? There is a tremendous amount of time, energy, stress, lost opportunities and sacrifice.

I am in a ROAD specialty. Many of my best friends from medical school are in ROAD specialties. They are not as "cush" as you think.
 
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If you can see yourself doing anything else other than medicine, you should ask yourself: do you really want to do medicine??? There is a tremendous amount of time, energy, stress, lost opportunities and sacrifice.

I am in a ROAD specialty. Many of my best friends from medical school are in ROAD specialties. They are not as "cush" as you think.

Medicine/Dentistry would just be a foot in the door to better opportunities in my view. Is there really a better route you would suggest where I can still go through the entrepreneurial route that doesn't include a tremendous amount of time, energy, stress, lost opportunities and sacrifice? AFAIK if you want to be successful in life you are going to have to make sacrifices regardless. Sure not every route takes 12 years to achieve, but not every route is as secure as medicine either. Not to mention I don't have a small loan of a million dollars to start a business with anyways;)
 

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Most of this is great advice. However, to get a somewhat more accurate idea of the dental side regarding income, competitiveness etc, I recommend seeing what they have to say over on that forum if you haven't already.

A number of dental specialities both pay your residency and increase your income (omfs and peds, as well as highly competitive spots in other specialities). All GPR and AEGD residencies pay, I believe.

Second, the reported dentist salaries are pulled down by accounting tricks (e.g. profits vs actual salary) and the fact that most dentists work 4 days a week with no call, which is definitely not the default in medicine.

So no, you don't have to be a specialist or entrepreneur to make decent money. If you don't insist on living in NYC or LA (super saturated for general dentists), you will certainly break 200k as an associate general dentist after a couple years assuming you're willing to work anything close to physician hours.

Then if you do run your own practice, you're going to at least double your income if you possess a modicum of business sense. That's setting aside the entrepreneurial types who oversee 2-3 practices and bring in 500k-million.

Then if we're talking about medical specialities, it's only fair to mention a peds dental residency - throw on another 1.5x multiplier onto the above. Similarly, with a OMFS residency, make it 2.5x.

In fact, OMFS consistently ranks at or near the top of all specialities (medical or dental) for hourly income along with derm. No, it's certainly not a given for any student, but neither is ROAD.

The other dental specialities also fare very well in this regard.

I do agree that orthodontics is a bad investment at this point in time given all the other options.

And the "nobody likes teeth" thing is almost too silly to address (and painfully reductionist to boot), so I'll just say I don't see what's so much crazier about specializing in teeth/gums/jaw than "just" eyes or "just" skin.

None of those fields are filled to the brim with life and death experiences; you're primarily involved with QOL. But they help patients significantly, provide significant employment flexibility, and you'll be expected to catch whatever cancer or systemic infection that presents.

Some of the dumping and sideways remarks are just baffling to me, but they're only from certain members; I like to think most on here are proud professionals who know how to work well as part of a large, multifaceted health team.
 
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Most of this is great advice. However, to get a somewhat more accurate idea of the dental side regarding income, competitiveness etc, I recommend seeing what they have to say over on that forum if you haven't already.

A number of dental specialities both pay your residency and increase your income (omfs and peds, as well as high competitive spots in other specialities). All GPR and AEGD residencies pay, I believe.

Second, the reported dentist salaries are pulled down by accounting tricks (e.g. profits vs actual salary) and the fact that most dentists work 4 days a week with no call, which is definitely not the default on medicine.

So no, you don't have to be a specialist or entrepreneur to make decent money. If you don't insist on living in NYC or LA (super saturated for general dentists), you will certainly break 200k as an associate general dentist after a couple years assuming you're willing to work anything close to physician hours.

Then if you do run your own practice, you're going to at least double your income if you possess a modicum of business sense. That's setting aside the entrepreneurial types who oversee 2-3 practices and bring in 500k-million.

Then if we're talking about medical specialities, it's only fair to mention a peds dental residency - throw on another 1.5x multiplier onto the above. Similarly, with a OMFS residency, make it 2.5x.

In fact, OMFS consistently ranks at or near the top of all specialities (medical or dental) for hourly income along with derm. No, it's certainly not a given for any student, but neither is ROAD.

The other dental specialities also fare very well in this regard.

I do agree that orthodontics is a bad investment at this point in time given all the other options.

And the "nobody likes teeth" thing is almost too silly to address (and painfully reductionist to boot), so I'll just say I don't see what's so much crazier about specializing in teeth/gums/jaw than "just" eyes or "just" skin.

None of those fields are filled to the brim with life and death experiences, but they help patients significantly, provide significant employment flexibility, and hey, sometimes you'll catch cancer or a systemic infection.

Some of the dumping and sideways remarks are just baffling to me, but they're only from certain members; I like to think most on here are proud professionals who know how to work to

Very well said. I actually have been scouring the dental forums a lot, that's where I got the idea of multiple practices and the business opportunities in dentistry. Currently, with dentistry I still feel there is a more straightforward path towards entrepreneurship, so I am definitely leaning towards dentistry, but as the previous poster @IMGASMD said, it's best to keep your options open. And this thread has been very insightful on the potential opportunities in medicine.

And yeah, dentists get absolutely no respect anywhere haha! But it's fine, I'm not in this for the prestige anyways. At the end of the day, my bank account matters more than what some stranger thinks of me whether I have a DDS or MD on my lab coat. I'm sure if dentistry was a medical sub specialty, it would actually be highly sought after as long as it gets the MD badge. Either way, I highly respect both professions. They do good to the world and help people in need. People might undervalue teeth, but imagine if you had to go through life with decaying teeth, not being able to eat ice cream because it hurts too much. Yikes!

You brought up a good point with OMFS, I guess they are a specialty of dentistry that is similar to the ROAD specialties in medicine. Very lucrative, and very competitive. Looking at the profit margins for oral surgery procedures such as getting wisdom teeth removed etc. I would say OMFS probably would leave most dental/medical specialties in the dust income wise, except maybe neuro/ortho surgeons. Even so, a private practice OMFS working full time probably produces in excess of 10k per day. Honestly starting an OMFS group, maybe by partnering with many GP's in the area, could be a very lucrative option.

This makes it interesting though, if you start comparing OMFS to ROAD, because they both have very similar paths, except one is through dental school and one through medical. What are your guys' thoughts on that. I figure that I would probably have roughly the same chances of becoming an OMFS as I would getting into a ROAD specialty, how would they compare?
 
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ProspectivePostPreDent

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Very well said. I actually have been scouring the dental forums a lot, that's where I got the idea of multiple practices and the business opportunities in dentistry. Currently, with dentistry I still feel there is a more straightforward path towards entrepreneurship, so I am definitely leaning towards dentistry, but as the previous poster @IMGASMD said, it's best to keep your options open. And this thread has been very insightful on the potential opportunities in medicine.

And yeah, dentists get absolutely no respect anywhere haha! But it's fine, I'm not in this for the prestige anyways. At the end of the day, my bank account matters more than what some stranger thinks of me whether I have a DDS or MD on my lab coat. I'm sure if dentistry was a medical sub specialty, it would actually be highly sought after as long as it gets the MD badge. Either way, I highly respect both professions. They do good to the world and help people in need. People might undervalue teeth, but imagine if you had to go through life with decaying teeth, not being able to eat ice cream because it hurts too much. Yikes!

You brought up a good point with OMFS, I guess they are a specialty of dentistry that is similar to the ROAD specialties in medicine. Very lucrative, and very competitive. Looking at the profit margins for oral surgery procedures such as getting wisdom teeth removed etc. I would say OMFS probably would leave most dental/medical specialties in the dust income wise, except maybe neuro/ortho surgeons. Even so, a private practice OMFS working full time probably produces in excess of 10k per day. Honestly starting an OMFS group, maybe by partnering with many GP's in the area, could be a very lucrative option.

This makes it interesting though, if you start comparing OMFS to ROAD, because they both have very similar paths, except one is through dental school and one through medical. What are your guys' thoughts on that. I figure that I would probably have roughly the same chances of becoming an OMFS as I would getting into a ROAD specialty, how would they compare?
Leaving aside the practicality of banking on a certain medical/dental specialty coming in (people do it, but the risk analysis is unique to you, and can you really be sure before you've taken a single grad course?),
one thing I would say is that any surgical speciality will require significant lifestyle sacrifices during residency. OMFS can be as cushy as you want later, but they put in 100+ hour weeks for a long time to get there.
 
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Leaving aside the practicality of banking on a certain medical/dental specialty coming in (people do it, but the risk analysis is unique to you, and can you really be sure before you've taken a single grad course?),
one thing I would say is that any surgical speciality will require significant lifestyle sacrifices during residency. OMFS can be as cushy as you want later, but they put in 100+ hour weeks for a long time to get there.

That's true, residency can be a pain. But from what I've heard dental school in general is pretty brutal because it is sort of like school+residency combined since general dentists don't have a formal residency. Those are sacrifices I can gladly make though, and given my interest in these medical/dental related fields it really shouldn't even feel too burdening.

I agree that banking on a residency is foolish, it was merely just a goal that I want to set for myself. I gotta say the fallback plan on the dental route seems a bit more appealing, because even if I fail to match, I can still be a general dentist and pursue my entrepreneurial dreams. If I can't get into any desired specialties in medicine, then I may be forced into a specialty I don't particularly like too much, one with long procedural hours and much less room for entrepreneurial growth. Unless you are a bad student, you probably should be able to match into some desirable specialty, but there's always that risk that you don't.
 
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LebronManning

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Second, the reported dentist salaries are pulled down by accounting tricks (e.g. profits vs actual salary) and the fact that most dentists work 4 days a week with no call, which is definitely not the default in medicine.

This is the default for all the medical fields we're discussing: Derm, Family Medicine, Peds, etc. It's not the default in MD fields where you're actively saving lives every day, but that's the tradeoff. Point is MD allows you to choose which one you want. Everyone reports lower salary than they actually make.

So no, you don't have to be a specialist or entrepreneur to make decent money. If you don't insist on living in NYC or LA (super saturated for general dentists), you will certainly break 200k as an associate general dentist after a couple years assuming you're willing to work anything close to physician hours.

Then if you do run your own practice, you're going to at least double your income if you possess a modicum of business sense. That's setting aside the entrepreneurial types who oversee 2-3 practices and bring in 500k-million.

Then if we're talking about medical specialities, it's only fair to mention a peds dental residency - throw on another 1.5x multiplier onto the above. Similarly, with a OMFS residency, make it 2.5x.

The point in comparing salaries is that comprehensively physicians will make more money. If one doesn't want to be an entrepreneur, then 100% of the time MDs are paid more. You can't compare oral surgeon to pediatrician. If you're gonna compare oral surgery to MD then compare it to Neurosurgeon who blow them out of the water. Compare salaried family physician to the most basic salaried dentist, and the MD will make more.

Now in entrepreneurship, it all changes because the businessman makes the money, not the initials. Even so, the physician shortage will always be great than dentist shortage allowing for less competition in the field and higher rate of success in business. There's a reason you see dental practice ads all over town but how often do you see a family physician advertising themselves? They don't need to because of the HUGE PCP shortage.

Also I'm not sure what you mean by "working anything close to physician hours." The fields that compare to dentistry (Family Practice and Peds) commonly have docs that work 9-5 four days a week.

In fact, OMFS consistently ranks at or near the top of all specialities (medical or dental) for hourly income along with derm. No, it's certainly not a given for any student, but neither is ROAD.

Actually OMFS ranks below most medical specialties in average salary, both surgical and non. Even considering an avg salary of 344K in OMFS, that's lower than all of ROAD. Also, Radiology and Anesthesia are not really competitive anymore and average to slightly above average students can match into them. Compared to needing to be top 3 in your class to have a chance at matching OMFS. Now of course there are OMFS that are making millions, but so are literally some people in every specialty in both fields so that doesn't matter. Just again illustrating, on average, physicians make more money no matter how you slice it.

And the "nobody likes teeth" thing is almost too silly to address (and painfully reductionist to boot), so I'll just say I don't see what's so much crazier about specializing in teeth/gums/jaw than "just" eyes or "just" skin.

Was being partially facetious with that comment but I agree with your sentiment that it is similar to just specializing in eyes or skin. I don't really like those pathways either. Beauty of medicine is that you can be an neurosurgeon or cardiologist and still blow everyone out of the water in terms of salary while doing amazing work. My point was that nobody likes teeth enough to warrant becoming a dentist for that reason. People generally choose it for the perceived lifestyle and because it's easier to get in than medicine.

None of those fields are filled to the brim with life and death experiences

You are in medicine in some of the fields mentioned. Again, I guess that's the difference.

And yeah, dentists get absolutely no respect anywhere haha! But it's fine, I'm not in this for the prestige anyways. At the end of the day, my bank account matters more than what some stranger thinks of me whether I have a DDS or MD on my lab coat.

Dentists are definitely respected members of our society but you're right in that it can't compare to the respect of a physician. I think the common thought when people think of dentists are smart people that just weren't good enough to be doctors. I don't think this and it's not true in all cases, but the general public thinks what they want. It is true that dentistry is less competitive than medicine and there's a reason for that.

I disagree with you in that prestige doesn't matter. Why do you care about your bank account? Why do you wanna drive a maserati instead of a camry? Why do you want a 2 mil house and not a 250K one? Because you want prestige. When we're young we think its all about the money. As we get older, we realize that WHAT WE DO matters almost as much as WHAT WE MAKE. In that case, MD will almost always win. Especially in the cases of hospital based fields saving lives - remember these guys are frequently making 1Mil+ too. For me, it's all about a balance.

This makes it interesting though, if you start comparing OMFS to ROAD, because they both have very similar paths, except one is through dental school and one through medical. What are your guys' thoughts on that. I figure that I would probably have roughly the same chances of becoming an OMFS as I would getting into a ROAD specialty, how would they compare?

Very very very wrong. ROAD is nowhere near as competitive as OMFS. Only the top 2-3 students of a dental class can get into OMFS. Any above average kid in medicine can get into Radiology or Anesthesia. Derm is probably as competitive as OMFS. But then remember there are like 10+ other fields in medicine that offer OMFS money with similar lifestyle including all the surgical branches. People think medicine for some reason is way more brutal than dentistry and it may be true in some arenas. But if you're comparing it to OMFS, then no. Surgeons in both fields work their tail off during residency (half a decade+ of 80 hour weeks), but they can both tailor their lifestyles to their choice after. I know private neurosurgeons who only do elective spine surgery about 50 hours a week and make millions.
 
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Actually OMFS ranks below most medical specialties in average salary, both surgical and non. Even considering an avg salary of 344K in OMFS, that's lower than all of ROAD. Also, Radiology and Anesthesia are not really competitive anymore and average to slightly above average students can match into them. Compared to needing to be top 3 in your class to have a chance at matching OMFS. Now of course there are OMFS that are making millions, but so are literally some people in every specialty in both fields so that doesn't matter. Just again illustrating, on average, physicians make more money no matter how you slice it.

Very very very wrong. ROAD is nowhere near as competitive as OMFS. Only the top 2-3 students of a dental class can get into OMFS. Any above average kid in medicine can get into Radiology or Anesthesia. Derm is probably as competitive as OMFS. But then remember there are like 10+ other fields in medicine that offer OMFS money with similar lifestyle including all the surgical branches. People think medicine for some reason is way more brutal than dentistry and it may be true in some arenas. But if you're comparing it to OMFS, then no. Surgeons in both fields work their tail off during residency (half a decade+ of 80 hour weeks), but they can both tailor their lifestyles to their choice after. I know private neurosurgeons who only do elective spine surgery about 50 hours a week and make millions.


Actually you are off base here. Let's just compare Derm for now because it is similar in terms of years of schooling, competitiveness, and lifestyle to OMFS. So I just pulled a dermatologist compensation report from medscape (I'm not really sure where you guys get your compensation reports from, this is the one I could find from a quick google search.)

Medscape: Medscape Access
"Dermatologists who make the most are in office-based single-specialty and solo practices ($413,000 and $407,000, respectively). Last year, earnings were highest for dermatologists in healthcare organizations ($395,000), which came in third this year but still with higher compensation ($401,000) than last year."
So the average private practice derm makes a bit over 400k.

And for OMFS
ADA 2015 report on specialty's average income

Table 3: Annual Net Income of Specialists in Private Practice, 2014

Type of Dentist Average

Oral and Maxillofacial Surgeons $413,410
Endodontists $325,840
Orthodontists and Dentofacial Orthopedists $301,760
Pediatric Dentists $347,310
Periodontists $257,960

Source: American Dental Association, Health Policy Institute, 2015 Survey of Dental Practice.
Copyright © 2015 American Dental Association.

As you can see, the average private practice OMFS is actually right up there with Derm. And since Derm is one of the higher paying specialties in medicine, I think the statement that most medical specialties are above OMFS in terms of income are false. The surgical residencies such as Plastic, ortho and neuro may be more lucrative than OMFS, but in general they work more hours than OMFS so pay per hours is approx the same.

As for prestige, it really doesn't matter for me at all. I'm sure it does to you, but everyone is different. I 100% won't care about prestige even when I am 70. I care about my bank account more because it is what will give me a good, comfortable life. Prestige only matters if you need validation from other people about your accomplishments. But I am pretty content with myself as is.

Putting all that to the side, I did have a few questions about the original topic. Would you happen to know how exactly practice acquisition works in the medical landscape. Do you just find retiring docs/selling docs to acquire satellite practices from, and then hire new docs to work at those practices? And how is the private practice landscape in general. I saw some statistics that only about 47% of physicians own their own practices now and the number keeps declining. Is the large corporate (i.e. hospital) sector of medicine taking over, where it's hard to start private practices and compete? I ask because in dentistry the same thing is happening with DSO's, but this revolution has just started so I'm hoping to hop on this bandwagon and start my own DDSO(Dentist owned DSO) while the concept is still in it's beginning stages.
If I were to attempt the same in medicine, am I too late to the party already and the corporate giants will stunt my growth, or would you say the outlook is still good? I think it was referenced in an earlier post where a larger corporate group will look to buy out any smaller groups, is that inevitable?

I know I just asked a buttload of questions haha. Thanks in advance!
 

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Actually you are off base here. Let's just compare Derm for now because it is similar in terms of years of schooling, competitiveness, and lifestyle to OMFS. So I just pulled a dermatologist compensation report from medscape (I'm not really sure where you guys get your compensation reports from, this is the one I could find from a quick google search.)

Medscape: Medscape Access
"Dermatologists who make the most are in office-based single-specialty and solo practices ($413,000 and $407,000, respectively). Last year, earnings were highest for dermatologists in healthcare organizations ($395,000), which came in third this year but still with higher compensation ($401,000) than last year."
So the average private practice derm makes a bit over 400k.

And for OMFS
ADA 2015 report on specialty's average income

Table 3: Annual Net Income of Specialists in Private Practice, 2014

Type of Dentist Average

Oral and Maxillofacial Surgeons $413,410
Endodontists $325,840
Orthodontists and Dentofacial Orthopedists $301,760
Pediatric Dentists $347,310
Periodontists $257,960

Source: American Dental Association, Health Policy Institute, 2015 Survey of Dental Practice.
Copyright © 2015 American Dental Association.

As you can see, the average private practice OMFS is actually right up there with Derm. And since Derm is one of the higher paying specialties in medicine, I think the statement that most medical specialties are above OMFS in terms of income are false. The surgical residencies such as Plastic, ortho and neuro may be more lucrative than OMFS, but in general they work more hours than OMFS so pay per hours is approx the same.

As for prestige, it really doesn't matter for me at all. I'm sure it does to you, but everyone is different. I 100% won't care about prestige even when I am 70. I care about my bank account more because it is what will give me a good, comfortable life. Prestige only matters if you need validation from other people about your accomplishments. But I am pretty content with myself as is.

Putting all that to the side, I did have a few questions about the original topic. Would you happen to know how exactly practice acquisition works in the medical landscape. Do you just find retiring docs/selling docs to acquire satellite practices from, and then hire new docs to work at those practices? And how is the private practice landscape in general. I saw some statistics that only about 47% of physicians own their own practices now and the number keeps declining. Is the large corporate (i.e. hospital) sector of medicine taking over, where it's hard to start private practices and compete? I ask because in dentistry the same thing is happening with DSO's, but this revolution has just started so I'm hoping to hop on this bandwagon and start my own DDSO(Dentist owned DSO) while the concept is still in it's beginning stages.
If I were to attempt the same in medicine, am I too late to the party already and the corporate giants will stunt my growth, or would you say the outlook is still good? I think it was referenced in an earlier post where a larger corporate group will look to buy out any smaller groups, is that inevitable?

I know I just asked a buttload of questions haha. Thanks in advance!

Medscape is known to be completely off base in regards to physician salaries haha; there's actually a lot of politics on why they publish "fake" data but that's for another day. The go to data is MGMA because its actually physician reporting among each other, and not publicly available, but I have a copy of MGMA 2015 which I can cite.

Here are average mid career salaries of just the MD specialties that are higher than the 413K OMFS you cited, according to MGMA 2015. This is just average, and some are clearly multitudes higher.

Neurosurgery: 1.03 Million
Orthopedic Spine Surgery: 825K
Interventional Cardiology: 658K
General Orthopedic Surgery: 620K
Dermatology: 605K
Radiation Oncology: 591K
Cardiovascular Surgery: 591K
Radiology: 580K
Gastroenterology: 574K
Interventional Radiology: 560K
Plastic Surgery: 547K
General Cardiology: 545K
Anesthesiology: 535K
Oncology: 502K
Urology: 441K
Pulmonary and Critical Care: 428K
Ophthalmology: 417K

Thus several medical specialties are higher than OMFS. Remember many of these are less competitive to get into OMFS and most work less hours than OMFS.

For your other questions:
Yes, acquiring practices from selling/retiring docs is most common but also practice expansion from scratch is very common if you have a large enough patient base. A lot of this is location dependent. Once you gain a reputation and have a 2 month long waiting list, you start finding locations where other physicians are booked out and open up shop there. The private practice landscape relies heavily on reputation and margins. If you have a good reputation practice-wide you will get patients. If your profit margins on the physicians working for you are high, you will start getting more contracts from hospitals to expand your services to them perhaps.

Yes there is a trend for corporate ownership and buyouts but its important to see who this is happening to. Mostly its happening to physicians who are older and no longer want to run a business so they sell out for a PHAT pay day. However, it is absolutely not too late. Private practice will always continue in select specialties that are not hospital based. Even surgeons who do non emergent cases these days are owning outpatient surgery centers and collecting facility fee on top of their fee for actually doing the surgery. Also, more and more physicians are simply working for hospitals because the hospitals have such lucrative deals with insurance companies that the docs make a killing in the hospital without having to worry about running a business. Running your own business is always more profitable, but not worth the time for most physicians who got into the field to cure pathophysiology. But the option of running your business is ALWAYS there so long as this country isn't socialist.
 
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Medscape is known to be completely off base in regards to physician salaries haha; there's actually a lot of politics on why they publish "fake" data but that's for another day. The go to data is MGMA because its actually physician reporting among each other, and not publicly available, but I have a copy of MGMA 2015 which I can cite.

Here are average mid career salaries of just the MD specialties that are higher than the 413K OMFS you cited, according to MGMA 2015. This is just average, and some are clearly multitudes higher.

Neurosurgery: 1.03 Million
Orthopedic Spine Surgery: 825K
Interventional Cardiology: 658K
General Orthopedic Surgery: 620K
Dermatology: 605K
Radiation Oncology: 591K
Cardiovascular Surgery: 591K
Radiology: 580K
Gastroenterology: 574K
Interventional Radiology: 560K
Plastic Surgery: 547K
General Cardiology: 545K
Anesthesiology: 535K
Oncology: 502K
Urology: 441K
Pulmonary and Critical Care: 428K
Ophthalmology: 417K

Thus several medical specialties are higher than OMFS. Remember many of these are less competitive to get into OMFS and most work less hours than OMFS.

For your other questions:
Yes, acquiring practices from selling/retiring docs is most common but also practice expansion from scratch is very common if you have a large enough patient base. A lot of this is location dependent. Once you gain a reputation and have a 2 month long waiting list, you start finding locations where other physicians are booked out and open up shop there. The private practice landscape relies heavily on reputation and margins. If you have a good reputation practice-wide you will get patients. If your profit margins on the physicians working for you are high, you will start getting more contracts from hospitals to expand your services to them perhaps.

Yes there is a trend for corporate ownership and buyouts but its important to see who this is happening to. Mostly its happening to physicians who are older and no longer want to run a business so they sell out for a PHAT pay day. However, it is absolutely not too late. Private practice will always continue in select specialties that are not hospital based. Even surgeons who do non emergent cases these days are owning outpatient surgery centers and collecting facility fee on top of their fee for actually doing the surgery. Also, more and more physicians are simply working for hospitals because the hospitals have such lucrative deals with insurance companies that the docs make a killing in the hospital without having to worry about running a business. Running your own business is always more profitable, but not worth the time for most physicians who got into the field to cure pathophysiology. But the option of running your business is ALWAYS there so long as this country isn't socialist.

Oh wow! I was severely mistaken on medical income. The data was just very hard to find lol. Well this has really shifted the playing field, gotta say.

As for reputation, how exactly do you build your reputation without advertising? Is it just word of mouth? Couldn't you just get a massive patient base through tactical advertising? The only reason I ask this is because building a reputation as a physician probably takes a long time (like if you look at top rated doctors across the country, they are usually 20+ years into their careers) . Ideally I want to experience exponential growth ASAP after I finish my residency and start practicing/expanding.

I don't really want to go the hospital route because I know 100% that I want to be my own boss in the future, that is one of the, if not the most important factor in me choosing my career. My mentality is that if I worked my butt off for 12+ years, I better be able to control every facet of my life moving forward. Then there's the obvious, the growth potential by owning a business is much higher than if you are an employee. But I won't fault anyone for going the hospital route because paid vacation is pretty enticing haha.
 

ProspectivePostPreDent

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This is the default for all the medical fields we're discussing: Derm, Family Medicine, Peds, etc. It's not the default in MD fields where you're actively saving lives every day, but that's the tradeoff. Point is MD allows you to choose which one you want. Everyone reports lower salary than they actually make.



The point in comparing salaries is that comprehensively physicians will make more money. If one doesn't want to be an entrepreneur, then 100% of the time MDs are paid more. You can't compare oral surgeon to pediatrician. If you're gonna compare oral surgery to MD then compare it to Neurosurgeon who blow them out of the water. Compare salaried family physician to the most basic salaried dentist, and the MD will make more.

Now in entrepreneurship, it all changes because the businessman makes the money, not the initials. Even so, the physician shortage will always be great than dentist shortage allowing for less competition in the field and higher rate of success in business. There's a reason you see dental practice ads all over town but how often do you see a family physician advertising themselves? They don't need to because of the HUGE PCP shortage.

Also I'm not sure what you mean by "working anything close to physician hours." The fields that compare to dentistry (Family Practice and Peds) commonly have docs that work 9-5 four days a week.



Actually OMFS ranks below most medical specialties in average salary, both surgical and non. Even considering an avg salary of 344K in OMFS, that's lower than all of ROAD. Also, Radiology and Anesthesia are not really competitive anymore and average to slightly above average students can match into them. Compared to needing to be top 3 in your class to have a chance at matching OMFS. Now of course there are OMFS that are making millions, but so are literally some people in every specialty in both fields so that doesn't matter. Just again illustrating, on average, physicians make more money no matter how you slice it.



Was being partially facetious with that comment but I agree with your sentiment that it is similar to just specializing in eyes or skin. I don't really like those pathways either. Beauty of medicine is that you can be an neurosurgeon or cardiologist and still blow everyone out of the water in terms of salary while doing amazing work. My point was that nobody likes teeth enough to warrant becoming a dentist for that reason. People generally choose it for the perceived lifestyle and because it's easier to get in than medicine.



You are in medicine in some of the fields mentioned. Again, I guess that's the difference.



Dentists are definitely respected members of our society but you're right in that it can't compare to the respect of a physician. I think the common thought when people think of dentists are smart people that just weren't good enough to be doctors. I don't think this and it's not true in all cases, but the general public thinks what they want. It is true that dentistry is less competitive than medicine and there's a reason for that.

I disagree with you in that prestige doesn't matter. Why do you care about your bank account? Why do you wanna drive a maserati instead of a camry? Why do you want a 2 mil house and not a 250K one? Because you want prestige. When we're young we think its all about the money. As we get older, we realize that WHAT WE DO matters almost as much as WHAT WE MAKE. In that case, MD will almost always win. Especially in the cases of hospital based fields saving lives - remember these guys are frequently making 1Mil+ too. For me, it's all about a balance.



Very very very wrong. ROAD is nowhere near as competitive as OMFS. Only the top 2-3 students of a dental class can get into OMFS. Any above average kid in medicine can get into Radiology or Anesthesia. Derm is probably as competitive as OMFS. But then remember there are like 10+ other fields in medicine that offer OMFS money with similar lifestyle including all the surgical branches. People think medicine for some reason is way more brutal than dentistry and it may be true in some arenas. But if you're comparing it to OMFS, then no. Surgeons in both fields work their tail off during residency (half a decade+ of 80 hour weeks), but they can both tailor their lifestyles to their choice after. I know private neurosurgeons who only do elective spine surgery about 50 hours a week and make millions.
By physician hours, I mean 45-50 hours which is considered fairly modest in medicine but undesirable to many dentists. No, 4 days a week with no call is not "the default" in multiple medical specialities.

Here's a link with the real numbers. Compare that with the 35 a typical general dentist works.

Anyways, any dentist working those 45-50 hours as an associate, unless they insist on living in one of a couple super metropolises, is certainly doing 200+ when they're up to speed, and yes, i'd seriously question your level of awareness if you wouldn't describe that as "decent money". So no, you don't need to be an entrepreneur or work crazy hours to make decent money as a GP. And obviously the potential as an owner is vastly greater.

As for the omfs comparisons, at the end of the day, oral surgeons who don't care about publishing or variety of procedures can just do private practice T&T and pull in 600k and still go to their kids' activities.

I don't even know what I'd do with that. Mid 200s is amazing for how I live.

Again, my claim is per hour, which is not what you were referencing with your numbers, and again I'm not talking about hospital/ academic guys, but private practice income optimizers. Whether they're 1 or 10 on the list doesn't really mean that much to me - I think this points to a fundamental disconnect between our respective outlooks.

So for example, you lost me with the car stuff and the million dollar house. I like Hondas and I loathe gated neighborhoods. My discretionary income goes to family outings at restaurants as well as vacations (not necessarily fancy resorts - just traveling without worrying about money). I value not missing out on my loved ones' lives before anything you describe.

You couldn't get me to care in 5 lifetimes that your car makes mine look like a turd on wheels. Similarly, you probably don't care that I bench or squat more than you do; everybody has their little points of vanity, sure, but they aren't always the same.

You describing your nice country club or your lawn care regimen to me is like trying to entice a lion with a beautiful mushroom risotto.

And you can believe yourself to be more important, too. That's fine with me. I just don't find that view to be helpful in general. Some of the greatest people I know work very common jobs which require little or no education. If I ever find myself devaluing my buddy because he works in, say, hvac, I hope someone slaps me.

But sure, if one of your patients ever returns from my office with some modest QOL improvement, whether it be a new shine on the chompers, a couple well-placed maxillary implants, or an early discovery of squamous cell carcinoma, just give me a nice pat on the head so that I can experience the approval of one of the important guys. A for effort, pal!

Anyways, a couple other points -
Yes, OMFS is a big leap, but there is absolutely a way to work the odds in your favor.

Ready for this? Get into one of the schools that boasts a perfect or near perfect record with their omfs hopefuls. The ivies, UConn, and UCLA, to name a few, achieve this regularly. My school with 45 (unranked) students per class produces 5-7 most years, and I haven't heard of anyone missing the boat.

If you go to LECOM, then yeah, you may be #1 in your class and still not match.

So bust your ass to get into a high level program, preferably unranked, and it goes from being a wild dream to a totally realistic one.

As far as not being good enough for med school, well, some dds/dmd couldn't get into md programs, sure, but of all the non-md graduate degrees, including podiatry, pharmacy, optometry, and yes even DO, dentistry has the highest matriculant GPAs/sGPAs (midway between MD and DO average), and that's with no grade replacement, AKA a free second crack at orgo/physics/whatever (which is/has been common in those other programs).

IOW, many could've done MD, and the rest could've likely succeeded in one of those non-md programs, but instead chose dentistry. And I think it comes down to the above disconnect.

Most of us worked hard and got the good grades and then made the conscious sacrifice of "cool points" (physician) for a malleable work schedule, while still being the top dog in our area (unlike, say, an NP, PA, optometrist, or debatably even podiatrist when you consider foot fellowship orthos). The public can think what they want.
 
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No, 4 days a week with no call is not "the default" in multiple medical specialities.

It is though in Peds, FM, Derm, Endocrinology, Rheumatology, Allergy, .... The link you gave is considering all specialties and of course acute hospital based physicians work way more to where the average physician works harder than avg dentist. Im simply talking about the specialties I listed above.

Anyways, any dentist working those 45-50 hours as an associate, unless they insist on living in one of a couple super metropolises, is certainly doing 200+ when they're up to speed, and yes, i'd seriously question your level of awareness if you wouldn't describe that as "decent money". So no, you don't need to be an entrepreneur or work crazy hours to make decent money as a GP. And obviously the potential as an owner is vastly greater.

I agree that is great money. I didn't say non entrepreneurial dentists can't make decent money, I just said they don't make MD money.

As for the omfs comparisons, at the end of the day, oral surgeons who don't care about publishing or variety of procedures can just do private practice T&T and pull in 600k and still go to their kids' activities.

Right and both neurosurgeons and orthopedic surgeons can make 800K doing private practice spine and go to kids' activities. Derm will make 600K working less than OMFS for sure. Just saying that anything that exists in dentistry also exists in medicine, but the converse isn't true. That's the point I wanted to get across to OP.

I agree with the rest of your points about there being a disconnect in our priorities and that's totally fine. Absolutely dentistry is very competitive and its applicants impressive. By saying MD matriculants are more competitive, I don't mean to dog on dentistry, but rather just making a matter of fact statement. It does come down to that disconnect of wanting the increased prestige, job satisfaction, etc. That doesn't take away from the fact that dentistry is one of the highest paying, respected, challenging, and prestigious professions around even if its second to MD in all those categories.
 
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This thread is getting derailed already by the whole dentistry vs medicine. I originally started this thread to explore the business side of medicine as compared to dentistry, not get into a pissing match about which profession is better lol. Nobody really cares, or atleast I personally don't care that much. If I had to choose between being an elite dentist or an elite doctor, I would choose neither. I would choose to be an elite businessman whose business happens to be in the field of either a dentistry or medicine. I'm just ambitious like that :p

Getting back on topic: Over the past two nights, I have just been thinking...what about the opportunity cost of a 4 year residency/fellowship or whatever extra you have to do after medical school/dental school for specializing? I mean in those 4 years if I choose to stay a GP (i.e. graduate at 26 and DON'T do any residency), then I could get a massive head start on my group. I could acquire my anchor practice, which puts up high production and has high cash flow. It seems that banks tend to give out practice loans generously as long as you show similar production because they know practice failure rates are pretty low. The big step is acquiring the anchor practice and getting it tuned to your likings, which could take 2-2.5 years out of the 4 year timeframe. And in the remaining 1.5 years you can look forwards to practice acquisition. Since you are still young with almost no savings, you will most likely have to look at small practices on the decline to purchase, since you won't want to tack on another 500k+ loan to your already existing 500k+ practice loan. But realistically you could grab another 2 satellite practices (maybe some that only work 2 days a week) for cheap and then hire associates or partner with other doctors (which will also help you save on the initial purchase price) to work those practices full time which will instantly increase production so long as tactical advertising keeps bringing in new patients. As an owner, you will get to keep some % of the practice profit without working in the practice at all. This is exactly what can be the beginning boost for your future empire!

I mean those 4 years are really precious. Residency seems like a huge opportunity cost because that is 4 years spent not working on growing your business. 4 years might not seem like much, but it is approximately 10% of your career if you plan on working for 40 years. And to add insult to injury, the 4 years lost could lead to a much bigger loss in growth in the following years because well run businesses usually experience exponential growth at their peaks as compared to when they started, so your peak years are shortened by 4 years.

What are your guys' thoughts on the opportunity cost of residency?
 

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Medscape is known to be completely off base in regards to physician salaries haha; there's actually a lot of politics on why they publish "fake" data but that's for another day. The go to data is MGMA because its actually physician reporting among each other, and not publicly available, but I have a copy of MGMA 2015 which I can cite.

Here are average mid career salaries of just the MD specialties that are higher than the 413K OMFS you cited, according to MGMA 2015. This is just average, and some are clearly multitudes higher.

Neurosurgery: 1.03 Million
Orthopedic Spine Surgery: 825K
Interventional Cardiology: 658K
General Orthopedic Surgery: 620K
Dermatology: 605K
Radiation Oncology: 591K
Cardiovascular Surgery: 591K
Radiology: 580K
Gastroenterology: 574K
Interventional Radiology: 560K
Plastic Surgery: 547K
General Cardiology: 545K
Anesthesiology: 535K
Oncology: 502K
Urology: 441K
Pulmonary and Critical Care: 428K
Ophthalmology: 417K

Thus several medical specialties are higher than OMFS. Remember many of these are less competitive to get into OMFS and most work less hours than OMFS.

For your other questions:
Yes, acquiring practices from selling/retiring docs is most common but also practice expansion from scratch is very common if you have a large enough patient base. A lot of this is location dependent. Once you gain a reputation and have a 2 month long waiting list, you start finding locations where other physicians are booked out and open up shop there. The private practice landscape relies heavily on reputation and margins. If you have a good reputation practice-wide you will get patients. If your profit margins on the physicians working for you are high, you will start getting more contracts from hospitals to expand your services to them perhaps.

Yes there is a trend for corporate ownership and buyouts but its important to see who this is happening to. Mostly its happening to physicians who are older and no longer want to run a business so they sell out for a PHAT pay day. However, it is absolutely not too late. Private practice will always continue in select specialties that are not hospital based. Even surgeons who do non emergent cases these days are owning outpatient surgery centers and collecting facility fee on top of their fee for actually doing the surgery. Also, more and more physicians are simply working for hospitals because the hospitals have such lucrative deals with insurance companies that the docs make a killing in the hospital without having to worry about running a business. Running your own business is always more profitable, but not worth the time for most physicians who got into the field to cure pathophysiology. But the option of running your business is ALWAYS there so long as this country isn't socialist.

Brother is a Radiologist and I am in dental school. Problem with this, you will always have someone to answer to. My bro hates this. So OP, if you are willing to be a dental practice owner and make $300k (which is reasonable) that is all fine and dandy but you have no one to answer to and no one beeping you to come in and no one disrupting family vacations and meals.

Take it with a grain of salt. It is not the income you have to consider but the lifestyle and life and death situations as well. Me, I like to work with my hands and not worry about killing anyone so I chose dental. Lots to consider. Plus $500k is really like $300k after taxes anyways because you are a W2. Dental practice owners get to keep more of their income.
 

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Brother is a Radiologist and I am in dental school. Problem with this, you will always have someone to answer to. My bro hates this. So OP, if you are willing to be a dental practice owner and make $300k (which is reasonable) that is all fine and dandy but you have no one to answer to and no one beeping you to come in and no one disrupting family vacations and meals.

Take it with a grain of salt. It is not the income you have to consider but the lifestyle and life and death situations as well. Me, I like to work with my hands and not worry about killing anyone so I chose dental. Lots to consider. Plus $500k is really like $300k after taxes anyways because you are a W2. Dental practice owners get to keep more of their income.

I don’t get your point. 90% of physicians can open up a practice just like a dentist.
 

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I don’t get your point. 90% of physicians can open up a practice just like a dentist.
Not anymore. Most physician essentially have no choice but to be employed by an existing practice. Most practices over the past are being bought up by large corporate practices or health systems. These in turn puts even more pressure on small private practices as the large corporate encourage referrals within their practices. Additionally the costs in running a private practice, the need for administrative overhead to submit and get increasingly decreasing reimbursements, the intense paperwork above and patients in running a business, the rules and regulations that put more strain on private providers, and just the time consuming nature of all this, makes opening and succeeding in an independent practice very difficult
 

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Not anymore. Most physician essentially have no choice but to be employed by an existing practice. Most practices over the past are being bought up by large corporate practices or health systems. These in turn puts even more pressure on small private practices as the large corporate encourage referrals within their practices. Additionally the costs in running a private practice, the need for administrative overhead to submit and get increasingly decreasing reimbursements, the intense paperwork above and patients in running a business, the rules and regulations that put more strain on private providers, and just the time consuming nature of all this, makes opening and succeeding in an independent practice very difficult

I agree with all of that and that's why physicians go work for hospitals and many make more money doing so. But I'm saying most of the above holds true for dentistry as well. The fact remains private practice is still a viable career for any physician if they are business minded enough. In medicine, the alternative is make similar or more money with a hospital. In dentistry, the ONLY way to make money is by being a business savant.
 

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I don’t get your point. 90% of physicians can open up a practice just like a dentist.

Yeah they absolutely can. I just know from two specialists that are family friends Cardiologist - always complains how catheters are half of what they use to be and how health insurance is slashing him apart and a OBGYN who retired because she didn't want to see more patients and had a hospital buy her out. It is a weird landscape if you rely on insurance which I didn't like on the business end. Hospital jobs are great with benefits and some even give pensions. We are really talking about apples and oranges here (dentistry versus medicine), they both are great fruits, it's just what tastes better to you.
 

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The user self-deleted their account. I guess they decided to major in business so they can make those fat stacks of money while not having to worry about GPA or studying for standardized exams like the DAT/MCAT. Guess they're going to be flying G6's and making seven figures from their own dorm room.
 
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