second thoughts

[eastcoast2021]

for some reason, this week has made me question whether starting my expensive ortho program is worth it. I am very interested in becoming an entrepreneur, and wonder if it'd just be smarter investing that money into a general practice and growing from there. I'm fortunate enough to be graduating debt free but go back and forth as to what I'll end up enjoying more. Regardless, I only envision myself practicing clinically 1-2 days a week down the line and being more involved in operations. what are your thoughts?

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[allDAT]

Ortho if you’re debt free. Less influence from insurance, basically no emergencies, no hygienists which are loss leaders with some insurance plans, and you can delegate so much. Also much cheaper to do a buildout if necessary.

 

[allDAT]

Ortho only gets questionable if you’re looking at 500k for your dental license and then another 300-400k for ortho. If you’re just paying for Ortho, no brained to go for it if you can.

 

[eastcoast2021]

Ortho only gets questionable if you’re looking at 500k for your dental license and then another 300-400k for ortho. If you’re just paying for Ortho, no brained to go for it if you can.

very true. I still worry about the opportunity cost of those 3 lost years though. idk

 

[allDAT]

very true. I still worry about the opportunity cost of those 3 lost years though. idk

The opportunity cost is mute because opportunities for new grad GPs are mostly trash until they have 3-5 years of experience. Orthos have high 6, close to 7 figure earning potential, general dentists for the most part do not (55-60% OH with a 1.5M office is where many top out as a single doc).

Starting pay for Ortho with zero experience is almost 3x the pay for a GP with 3 years of experience before bonuses.

Most GPS have a 5-15 year ramp to peak earnings.

 

[AONLINE]

If the new Georgia Ortho program is the only option for a person, is it still worth it to attend? What if that person has zero debt from dental school, would that change the answer?

 

[allDAT]

If the new Georgia Ortho program is the only option for a person, is it still worth it to attend? What if that person has zero debt from dental school, would that change the answer?

I’m not familiar with Georgia’s Ortho program. Is it particularly expensive or long?

For the most part, an Ortho certificate is an Ortho certificate. Doesn’t matter where you got it from.

 

[frozenicecreamDMD]

The opportunity cost is mute because opportunities for new grad GPs are mostly trash until they have 3-5 years of experience. Orthos have high 6, close to 7 figure earning potential, general dentists for the most part do not (55-60% OH with a 1.5M office is where many top out as a single doc).

Starting pay for Ortho with zero experience is almost 3x the pay for a GP with 3 years of experience before bonuses.

Most GPS have a 5-15 year ramp to peak earnings.

so you are saying assuming GP daily guarantee is 500$ a day or 30% adjusted production ortho will get 1500$ guarantee before start/finish bonus?

from where I am, ortho is getting 1200$ daily but the thing is they only work part time and have to piece multiple offices together. nearby is a group ortho offices that build 3 offices between 2 ortho partners that alternate 3 days/week at each office ----if you do this you still have overhead such as rent lease and staff cost (one of the biggest overhead in dental office is rent lease and staff cost)

for GPs, I guess depending on your risk tolerance and skills, 5-15 years to peak earnings seem so long unless you are in super saturated market. From where I am, probably take 3-4 years max for you to build up skills and open your own office. some GPs are ready to retired in 15-20 years of working.

 

[2TH MVR]

for some reason, this week has made me question whether starting my expensive ortho program is worth it. I am very interested in becoming an entrepreneur, and wonder if it'd just be smarter investing that money into a general practice and growing from there. I'm fortunate enough to be graduating debt free but go back and forth as to what I'll end up enjoying more. Regardless, I only envision myself practicing clinically 1-2 days a week down the line and being more involved in operations. what are your thoughts?

Like others have posted. Really depends on the total DS and residency debt. What that number is is up for debate.

Sounds like being an entrepreneur is what you really want. If so ..... IMO it is probably easier to be an entrepreneur as a GP. I've seen some amazing start ups in the dental field (Risas Dental, Somos Dental) by some really talented, business minded GPs. What I don't see is alot of Ortho type multiple practices. This is in a saturated market. There are a few, but I don't see them killing it. The problem with ortho is EVERYONE is offering it. Private ortho practices. Private GPs. Private Pedos. Corporate practices which are EVERYWHERE. I just think that general dentistry has a broader appeal with a much larger patient pool. It's easier to attract more patients as a general practice which OFFERS ortho services than a stand-alone ortho practice.

Now the flipside. There are plenty of ortho jobs. I had posted earlier that the DSO I work for has been trying to hire 2-3 new orthos in the last 6 months. They were concerned that I might jump ship .... so they actually gave me a raise. . Trust me. I had plenty of offers. If you are good .... you can work full time or PT. Your call. I've been covering for the other ortho vacancies .... so I've been working 6 days a week.
As was posted earlier ..... generally speaking you will make MORE $$ as an ortho vs. GP . I make 2-3X what my GP counterparts make at the DSO. So ...if you love ortho ..... you can take your larger paychecks and still INVEST in whatever you want.

I do not believe in lost opportunity costs. As an ortho .... I caught up to my GP classmates pretty quickly .... and surpassed them.

 

[eastcoast2021]

Like others have posted. Really depends on the total DS and residency debt. What that number is is up for debate.

Sounds like being an entrepreneur is what you really want. If so ..... IMO it is probably easier to be an entrepreneur as a GP. I've seen some amazing start ups in the dental field (Risas Dental, Somos Dental) by some really talented, business minded GPs. What I don't see is alot of Ortho type multiple practices. This is in a saturated market. There are a few, but I don't see them killing it. The problem with ortho is EVERYONE is offering it. Private ortho practices. Private GPs. Private Pedos. Corporate practices which are EVERYWHERE. I just think that general dentistry has a broader appeal with a much larger patient pool. It's easier to attract more patients as a general practice which OFFERS ortho services than a stand-alone ortho practice.

Now the flipside. There are plenty of ortho jobs. I had posted earlier that the DSO I work for has been trying to hire 2-3 new orthos in the last 6 months. They were concerned that I might jump ship .... so they actually gave me a raise. . Trust me. I had plenty of offers. If you are good .... you can work full time or PT. Your call. I've been covering for the other ortho vacancies .... so I've been working 6 days a week.
As was posted earlier ..... generally speaking you will make MORE $$ as an ortho vs. GP . I make 2-3X what my GP counterparts make at the DSO. So ...if you love ortho ..... you can take your larger paychecks and still INVEST in whatever you want.

I do not believe in lost opportunity costs. As an ortho .... I caught up to my GP classmates pretty quickly .... and surpassed them.

this is the rub for me though. my friend mentioned finding an associateship wouldn't be difficult but I could only do that for a few months post graduation. I just cant see myself working under another someone and have to be my own boss :/ I agree the market is really scary right now. ive talked to all my friends in pedo and they just plan on hiring an orthodontist in their offices part time. this is not a model I would like to be a part of

 

[allDAT]

so you are saying assuming GP daily guarantee is 500$ a day or 30% adjusted production ortho will get 1500$ guarantee before start/finish bonus?

from where I am, ortho is getting 1200$ daily but the thing is they only work part time and have to piece multiple offices together. nearby is a group ortho offices that build 3 offices between 2 ortho partners that alternate 3 days/week at each office ----if you do this you still have overhead such as rent lease and staff cost (one of the biggest overhead in dental office is rent lease and staff cost)

for GPs, I guess depending on your risk tolerance and skills, 5-15 years to peak earnings seem so long unless you are in super saturated market. From where I am, probably take 3-4 years max for you to build up skills and open your own office. some GPs are ready to retired in 15-20 years of working.

That’s about right with 500 vs 1200/day. I’m seeing about 550/day for a new grad as a routine offer now and Ortho around 1300 on the low end and 2k on the high end. Pedo base around $1000. This is in CA. Associates get 25% of collections, Ortho gets 40%.

You won’t reach peak earnings until your debt is paid. Most practice loans are on a 10 year term, so you should make more (NET, not gross) after you’ve paid down the loan 5-15 years after graduation. For example, that would be 5 years as an associate, 10 as an owner, then you’re close to peak earnings where the solo doc often continues to build up over the next few years and then plateaus. Then earnings decline with age as overhead from legacy staff increases and collections either decrease or hold steady. The decline is due in large part to inflation eroding our fees as PPOs control at least 50% of the collections in most offices.


As far as overhead goes. Rent for orthos really isn’t a big deal. In most markets 1 or 2 cases per month will cover the rent so satellite offices can make a lot of sense for an Ortho to expand their market share.

Very few GPs are ready to retire after just 20 years of practice. Just 3% of us can retire by the age of 60. There’s a long thread on dental town all about it.

Antidotally I know many GPs working into their 70s, likely because they have to, not because they want to. The main reason here is that we don’t have access to retirement plans on our own and you have to set them up through the office if you own one. So early in our careers most dentists do not max out their retirement savings which are already lagging behind your age group who entered the workforce after college. Student loan planner has a blog post where they did a break even analysis and a DDS breaks even really late in life with regards to retirement. This of course is ignoring a lot of factors like higher average earnings, possibly a better work life balance, etc but it’s worth noting.

 

[allDAT]

this is the rub for me though. my friend mentioned finding an associateship wouldn't be difficult but I could only do that for a few months post graduation. I just cant see myself working under another someone and have to be my own boss :/ I agree the market is really scary right now. ive talked to all my friends in pedo and they just plan on hiring an orthodontist in their offices part time. this is not a model I would like to be a part of

Pedo Ortho is a powerful combo. If I was an Ortho, I’d partner with 2 pedos and have 1 office. The 2 pedos see 30-40 patients a day each, and feed your Ortho schedule. Assuming you have the right demographics.

 

[Lemillion]

Pedo here. I know you mentioned your pedo friends want to hire an ortho to join the team part time. The tricky thing with that is their office needs to be busy enough to keep the ortho happy. Most of my ortho friends don't have a strong desire to work under a pedo office because they would run into more interceptive ortho (young and behavior management) or they like the flow of a full ortho office. One of my ortho friends is part time for a pedo office and he's frustrated with the lack of case starts and losing all the referral sources from other offices.

I am in the same line of thought that if the debt is minimal for you, ortho would be worth it. The only argument I can think of not doing your program is if the costs are exorbitantly high or you have some circumstances that prevent you (family, significant other, health issues).

 

[Pablo Sanchez]

Nobody on here is going to have the answer for you. You know yourself better than anyone. I think that it is easier to be an entrepreneur as a GP. I also think that once you move from "dentist" to "business owner" the sky is the limit in terms of income. I personally am choosing to go the GP route. If you are creative, care about people, and put good systems in place, you can make beaucoup money. For me personally, the sooner I can start and get experience, the better.

We come from a very smart group of people. Education is valued by people in professional school. A lot of people think specializing is the key to success. Do well in dental school. Go on for more and more education. Eventually you have to draw a line and hit the ground running. Going into debt to get more specialized education isn't necessarily a good thing. The same people who tell you to go more and more in debt for education are the same people who lease their lives.

If you're looking purely at associate salary, which you're not, I'd ask you to consider the 2018 American Association of Orthodontics Student Loan Survey. Particularly page 31.

Average ortho resident expects to have a salary of $206,000. Their actual salary upon graduation? $163,000.

 

[2TH MVR]

this is the rub for me though. my friend mentioned finding an associateship wouldn't be difficult but I could only do that for a few months post graduation. I just cant see myself working under another someone and have to be my own boss :/ I agree the market is really scary right now. ive talked to all my friends in pedo and they just plan on hiring an orthodontist in their offices part time. this is not a model I would like to be a part of

I completely understand. Look. I worked privately for 25 plus years. Owned 2-3 practices. Last 4 yrs with the DSO. I chose the DSO route because there was no way I was going to work for another dentist. (Ego issue ). None of us want to be employees answering to other dentists or invisible owners (DSOs). It works for me since I'm older, but not as a young new dentist/ortho.

I've mentioned this before. DO BOTH. Assuming you go the ortho route. Work PT for a Corp/pedo whatever and own a private practice on the side. Build capital. Then partner up with some bright business minds and build a dental business. I know a large perio practice that has it's own CEO. Not just in name, but in background. They're killing it. Multiple practices with multiple partners. Another ortho/GP partnership built a DSO like dental chain that caters to the hispanic population (large numbers and increasing every day in Phoenix/Tucson). They're killing it. I'm envious. I wish I had those contacts or vision early on.

The point is. Most practices are offering ortho services. Being an ortho will help you further this partnership in some type of future business dental venture. What's the worst that could happen? You end up as a simple orthodontist. Not so bad. Right? Ortho is by far the most desirable profession when it comes to ease of work, delegation of assts, longevity, just being happy.

 

[charlestweed]

Regardless, I only envision myself practicing clinically 1-2 days a week down the line and being more involved in operations. what are your thoughts?

This is every dentist’s (and mine too) dream: open an office (or offices) and hire office manager and associate dentists to do all the work for you. Who doesn’t want to work less and make more? Most successful dentists that I know still work 4-5 days a week….and on the weekends. The only dentist that I know who can do this is Coldfront. In dentistry (except for ortho), you have to sit down and spend time to perform the procedure in order to get paid. And in order to attract more new patients and continue to get paid, you have to continue to work hard to maintain your good reputation in the community. Doctor patient relationship is very important in dentistry. This is why dentistry will never be completely taken over by big corporations like what you see in pharmacy and optometry. As soon as you ignore your patients and let your associate dentists and office manager run the office for you, it will decline quickly. Nobody cares about your office the same way that you do. Dentistry is already a very saturated field (due to the openings of new dental schools in the last 10 years). There are dental offices everywhere.....even in rural areas. If you don’t take good care of your patients, they will go see another dentist down the street.

 

[charlestweed]

I completely understand. Look. I worked privately for 25 plus years. Owned 2-3 practices. Last 4 yrs with the DSO. I chose the DSO route because there was no way I was going to work for another dentist. (Ego issue ). None of us want to be employees answering to other dentists or invisible owners (DSOs). It works for me since I'm older, but not as a young new dentist/ortho.

I think this “Ego Issue” is the reason why a lot of young ortho grads can't find jobs after graduation.

 

[2TH MVR]

I think this “Ego Issue” is the reason why a lot of young ortho grads can't find jobs after graduation.

So true lol. I nurtured my EGO for so many years. But I've earned it. It's part of my personality right or wrong. New ortho grads haven't earned anything yet. I agree .... they need to be less picky. The ortho scene has changed, but there are plenty of jobs available. Get a job at a DSO and open,buy a small private practice at the same time. So easy. Most of the general dentists, specialists at my DSO do this. The ones that only work for the DSO. They are typically the ones complaining all the time .... and for the most part .... seem unhappy.

 

[sonotsure]

I have a question for the older dentists/orthodontists on here. I am in a similar situation to the OP in that I will be attending an expensive ortho program in just a few weeks, however, I already have approximately 180k in debt from dental school. This will leave me close to 450/500k after everything is said and done.

While I have accepted this fate and I'm not considering not going to residency, part of me still wants to know that I won't be in deep trouble when I finish my program. I of course plan on working very hard after residency to repay my loans but I'd like to start my program with my eyes wide open. Do any of you know someone in a debt situation similar to mine that has been able to manage it reasonably? I'm not married yet so I have not considered a likely dual income in the future yet but any advice or opinions would be greatly appreciated!

 

[8_man]

I have a question for the older dentists/orthodontists on here. I am in a similar situation to the OP in that I will be attending an expensive ortho program in just a few weeks, however, I already have approximately 180k in debt from dental school. This will leave me close to 450/500k after everything is said and done.

While I have accepted this fate and I'm not considering not going to residency, part of me still wants to know that I won't be in deep trouble when I finish my program. I of course plan on working very hard after residency to repay my loans but I'd like to start my program with my eyes wide open. Do any of you know someone in a debt situation similar to mine that has been able to manage it reasonably? I'm not married yet so I have not considered a likely dual income in the future yet but any advice or opinions would be greatly appreciated!

Not old or working, but I’ll just throw in my two cents.

$500K debt is definitely “manageable,” as long as you keep the live-like-a-student mentality for your first few years in practice. Things will move along even quicker if you make additional compromises, such as working rural and/or in a state with no income tax, delay home ownership, refinance your loans, etc.

You may also opt to take on even more debt and buy into a practice, which in theory would significantly increase your income and allow you to grow wealth quicker once you pass the break-even point. But this is entirely up to your own risk tolerance and your ability to leverage debt.

Another option is to marry rich lol.

 

[kobe4554]

Orthos have high 6, close to 7 figure earning potential, general dentists for the most part do not (55-60% OH with a 1.5M office is where many top out as a single doc).

Is it actually somewhat common for GPs to make this much? Thats around 600k gross income right? Im surprised

 

[deleted1082923]

Is it actually somewhat common for GPs to make this much? Thats around 600k gross income right? Im surprised

That’s not that common for gps to make that much. Most top out at like 300-400k pretax.

 

[sonotsure]

Not old or working, but I’ll just throw in my two cents.

$500K debt is definitely “manageable,” as long as you keep the live-like-a-student mentality for your first few years in practice. Things will move along even quicker if you make additional compromises, such as working rural and/or in a state with no income tax, delay home ownership, refinance your loans, etc.

You may also opt to take on even more debt and buy into a practice, which in theory would significantly increase your income and allow you to grow wealth quicker once you pass the break-even point. But this is entirely up to your own risk tolerance and your ability to leverage debt.

Another option is to marry rich lol.

Marrying rich is my #1 priority following graduation

But seriously, it's reassuring to know that my debt load is not going to be the end of the world, considering that I'm more than okay making those compromises you mentioned.

 

[allDAT]

Is it actually somewhat common for GPs to make this much? Thats around 600k gross income right? Im surprised

No. It’s not common at all. The average dental office collects around 750k per year and has 67% OH if I remember correctly.

The majority of GPs struggle to hit the 1M mark in collections. Those that do hit 1M usually top out around 1.5M and it’s hard to sustain as a solo doctor for more than a few years. Both because of staff issues and because of the physical demands. You’re really cranking dentistry out with 1.5 M in collections assuming 25% of that is hygiene. You can add associates but that’s changing the OH of the office and the business model.

It’s physically much easier to sustain 1M in Ortho collections than to sustain 1M in GP collections.

 

[allDAT]

I have a question for the older dentists/orthodontists on here. I am in a similar situation to the OP in that I will be attending an expensive ortho program in just a few weeks, however, I already have approximately 180k in debt from dental school. This will leave me close to 450/500k after everything is said and done.

While I have accepted this fate and I'm not considering not going to residency, part of me still wants to know that I won't be in deep trouble when I finish my program. I of course plan on working very hard after residency to repay my loans but I'd like to start my program with my eyes wide open. Do any of you know someone in a debt situation similar to mine that has been able to manage it reasonably? I'm not married yet so I have not considered a likely dual income in the future yet but any advice or opinions would be greatly appreciated!

You should be able to manage 500k in student loans as an Ortho. Use REPAYE until you lose the interest subsidy, live below your means, save, and pay down debt while also making progress towards your larger goals.

 

[2TH MVR]

I have a question for the older dentists/orthodontists on here. I am in a similar situation to the OP in that I will be attending an expensive ortho program in just a few weeks, however, I already have approximately 180k in debt from dental school. This will leave me close to 450/500k after everything is said and done.

While I have accepted this fate and I'm not considering not going to residency, part of me still wants to know that I won't be in deep trouble when I finish my program. I of course plan on working very hard after residency to repay my loans but I'd like to start my program with my eyes wide open. Do any of you know someone in a debt situation similar to mine that has been able to manage it reasonably? I'm not married yet so I have not considered a likely dual income in the future yet but any advice or opinions would be greatly appreciated!

Compared to others (over 500K to be a general dentist) ..... you're debt is very doable. Like others have posted. Live like a poor student. We all did this. I didn't buy my 1st home until three years after graduation. Drove a cheap car for those three years also. Wife worked and brought in a little money.

It is very possible to gross over 300K working for a DSO as an ortho . Yes. That is 5-6 days a week. Do that 1st to start building capital and paying down your debt. During this time .... start researching your options for a private practice. Ortho practices are not selling for alot of money relative to other practices. Or consider a practice from scratch. But do your research on the area. Consult with @charlestweed on building a practice economically. Then do both. DSO and private practice. When your private practice takes off .... dump the DSO. But the DSO is a nice fall back situation.

Be excited. You're going to be an orthodontist.