Stay away from orthodontics

[Orthodontist1982]

Yes I said it. I am currently a recent ortho graduate and I can tell all on here the market is screwed! It is very difficult for me or my coresidents to find employment. The best offer you will get is a part time gig at some slime GP office looking to make some money off of you or a corporate gig seeing 80 patients a day. It is not just saturated areas too, the rural areas there's no opportunity. It's basically start up and suffer for a few years or become a slave to the chains. There is a major downshift in the field, it was estimated that the past year there was an average of 1/3 decrease in production for ortho offices! Did you read that? One third less production on average! Not to mention I have to compete with GPs doing invisalign or 6 month smiles and less kids needing braces. Expect to make similar to what your GP buddies make as associates. I'm looking to renounce the specialty and do some GP work to pay the bills. I'm just trying to give some advice, call me bitter all you want. I love orthodontics, but I can't make much money doing it. The ortho dream to dental students is a dream. A dream that's dead.

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[DoWork91]

Can you comment on which specialties are doing well?

 

[Rambunctious]

-

 

[Silent Cool]

Yes I said it. I am currently a recent ortho graduate and I can tell all on here the market is screwed! It is very difficult for me or my coresidents to find employment. The best offer you will get is a part time gig at some slime GP office looking to make some money off of you or a corporate gig seeing 80 patients a day. It is not just saturated areas too, the rural areas there's no opportunity. It's basically start up and suffer for a few years or become a slave to the chains. There is a major downshift in the field, it was estimated that the past year there was an average of 1/3 decrease in production for ortho offices! Did you read that? One third less production on average! Not to mention I have to compete with GPs doing invisalign or 6 month smiles and less kids needing braces. Expect to make similar to what your GP buddies make as associates. I'm looking to renounce the specialty and do some GP work to pay the bills. I'm just trying to give some advice, call me bitter all you want. I love orthodontics, but I can't make much money doing it. The ortho dream to dental students is a dream. A dream that's dead.

@Shunwei told me something similar about the Ortho field.

Check out this guy with 700K+ of Ortho debt:

https://www.flickr.com/photos/consumersunionoftheus/sets/72157629851738980/

Now, I'm not sure if you are a troll or not, but other Orthodontists on this forum have corroborated (to some degree) what you are saying.

Any other orthos want to chime in?

@charlestweed
@ortho lurker
@BlueToothHunter

 

[Orthodontist1982]

I can't really comment as to which specialities are doing well, I don't really know. Ortho is in the pits though . The field is in pretty terrible shape right now. It's become somewhat of a trade. After looking for a few job for a while, it gets pretty disheartening. Talk to any ortho right now, any. We are all in the same boat and everyone feels the same way. The AAO has done nothing to help. The ortho tx results have gone way down in this country. As to the guy with 700k debt, its a lot more common than you think. Throw in the fact we have been in residency longer than a GP and come out with offers of 600 per day. Gimme a break. Oh yea, you don't believe me, try looking for an ortho job right now.

 

[Silent Cool]

I can't really comment as to which specialities are doing well, I don't really know. Ortho is in the pits though . The field is in pretty terrible shape right now. It's become somewhat of a trade. After looking for a few job for a while, it gets pretty disheartening. Talk to any ortho right now, any. We are all in the same boat and everyone feels the same way. The AAO has done nothing to help. The ortho tx results have gone way down in this country. As to the guy with 700k debt, its a lot more common than you think. Throw in the fact we have been in residency longer than a GP and come out with offers of 600 per day. Gimme a break. Oh yea, you don't believe me, try looking for an ortho job right now.

What do you mean when you say the tx results have gone down?

 

[Orthodontist1982]

What do you mean when you say the tx results have gone down?

With the GPs treating invisalign, fast braces, 6 month smiles only getting the front 6 straight, patients have no idea what an ideal ortho finish is anymore. Just because the front 6 are straight does not mean a case is anywhere near an acceptable finish. The future of our specialty is going to be absolutely involved in doing general dentistry, that's the only way we will be able to survive. I'm in 425k debt, imagine getting your loan due dates with no job? And everyone and their brother is trying to make a dime off of you, while GPs are doing crap ortho? My colleague with their own startup a say referrals are few and far between from GPs now so I am 1000% prepared to do simple general dentistry. At this point it is either that or go into bankruptcy and starve. Again, if you don't believe me I don't really care. You will find out once you graduate from your ortho program expecting showers of money. I just wanted to give a forewarning of where the field is headed.

 

[Silent Cool]

With the GPs treating invisalign, fast braces, 6 month smiles only getting the front 6 straight, patients have no idea what an ideal ortho finish is anymore. Just because the front 6 are straight does not mean a case is anywhere near an acceptable finish. The future of our specialty is going to be absolutely involved in doing general dentistry, that's the only way we will be able to survive. I'm in 425k debt, imagine getting your loan due dates with no job? And everyone and their brother is trying to make a dime off of you, while GPs are doing crap ortho? My colleague with their own startup a say referrals are few and far between from GPs now so I am 1000% prepared to do simple general dentistry. At this point it is either that or go into bankruptcy and starve. Again, if you don't believe me I don't really care. You will find out once you graduate from your ortho program expecting showers of money. I just wanted to give a forewarning of where the field is headed.

I'm not in an Ortho program, but I've followed the market for many years.

In what part of the country are you practicing?
Why don't you buy a general practice?
How much tuition did you pay for your Ortho residency?

 

[Orthodontist1982]

I'm not in an Ortho program, but I've followed the market for many years.

In what part of the country are you practicing?
Why don't you buy a general practice?
How much tuition did you pay for your Ortho residency?

I'm in the NE suburbs (no I'm not in NYC or a major city even though they are worse). I actually went to a hospital based program so I had little tuition, I know others with many more debt. That is an option, I am weighing all my options right now. All areas are hurting for orthos now, I don't care what anyone tells you. All my gp buddies make more. Orthos not such a great job when you have NO job.

 

[BlueToothHunter]

Orthodontics business has changed forever... this is going to be the new normal. So, for those who entered the orthodontic field with an expectation of a golden parachute/spoon (making $500K annual salary as an associate) would be very disappointed. A lot of the younger orthodontic graduates will find it almost impossible to land a steady, full time associate position (as mentioned above) in the traditional private practice setting. Most will, however, find a position within a network of corporate dental offices or work as an in-house orthodontist for a GP dentist or a pediatric dentist.

Whether we like it or not, these changes, I believe, are permanent. The public wants the best treatment at the lowest cost possible. They shop online. Compare prices. If the GP can provide cheaper braces, then people will go there. There will be no such thing as the "best" specialty in dentistry anymore... only declining specialties (that's another topic).

Amongst all these madness, look up Dr Ben Burris of Arkansas, I really think he's spot on when he's preaching to the young orthodontists that we should look at orthodontics as a business, not as a mom & pop small business. We shouldn't be just hoping to get the top 10% of the population, but the entire population to walk through the door. We shouldn't let our professional egos get in the way of thinking how we should run the office. Medicaid, DMO's, HMO's, PPO's... take every single insurances out there and take volume. Some of you will agree, some will hate the idea. But like I said, this is the new normal in orthodontic business....

@Shunwei told me something similar about the Ortho field.

Check out this guy with 700K+ of Ortho debt:

https://www.flickr.com/photos/consumersunionoftheus/sets/72157629851738980/

Now, I'm not sure if you are a troll or not, but other Orthodontists on this forum have corroborated (to some degree) what you are saying.

Any other orthos want to chime in?

@charlestweed
@ortho lurker
@BlueToothHunter

 

[Silent Cool]

Orthodontics business has changed forever... this is going to be the new normal. So, for those who entered the orthodontic field with an expectation of a golden parachute/spoon (making $500K annual salary as an associate) would be very disappointed. A lot of the younger orthodontic graduates will find it almost impossible to land a steady, full time associate position (as mentioned above) in the traditional private practice setting. Most will, however, find a position within a network of corporate dental offices or work as an in-house orthodontist for a GP dentist or a pediatric dentist.

Whether we like it or not, these changes, I believe, are permanent. The public wants the best treatment at the lowest cost possible. They shop online. Compare prices. If the GP can provide cheaper braces, then people will go there. There will be no such thing as the "best" specialty in dentistry anymore... only declining specialties (that's another topic).

Amongst all these madness, look up Dr Ben Burris of Arkansas, I really think he's spot on when he's preaching to the young orthodontists that we should look at orthodontics as a business, not as a mom & pop small business. We shouldn't be just hoping to get the top 10% of the population, but the entire population to walk through the door. We shouldn't let our professional egos get in the way of thinking how we should run the office. Medicaid, DMO's, HMO's, PPO's... take every single insurances out there and take volume. Some of you will agree, some will hate the idea. But like I said, this is the new normal in orthodontic business....

Sounds in line with everything else I have heard!

 

[comatose]

Okay this is not true. The orthos that work for the corporation I work for make quite a bit, I would venture to say close to 500k annually. And no don't ask me what corporation I work for. But orthos definitely have it made. I curse myself for not going into ortho because my back hurts like hell all the time. To the OP quit your b*tchin, you're in the best dental specialty.

 

[Mad Jack]

Sounds like OP has no business or networking skills.

The best orthodontists I've known weren't looking for jobs they were looking for markets.

But even barring that, some solid networking would land you a job with a decent chain. I've never met an orthodontist that made less than 250k in the NE, even as an employee.

 

[Miley Cyrus.]

Orthodontics business has changed forever... this is going to be the new normal. So, for those who entered the orthodontic field with an expectation of a golden parachute/spoon (making $500K annual salary as an associate) would be very disappointed. A lot of the younger orthodontic graduates will find it almost impossible to land a steady, full time associate position (as mentioned above) in the traditional private practice setting. Most will, however, find a position within a network of corporate dental offices or work as an in-house orthodontist for a GP dentist or a pediatric dentist.

Whether we like it or not, these changes, I believe, are permanent. The public wants the best treatment at the lowest cost possible. They shop online. Compare prices. If the GP can provide cheaper braces, then people will go there. There will be no such thing as the "best" specialty in dentistry anymore... only declining specialties (that's another topic).

Amongst all these madness, look up Dr Ben Burris of Arkansas, I really think he's spot on when he's preaching to the young orthodontists that we should look at orthodontics as a business, not as a mom & pop small business. We shouldn't be just hoping to get the top 10% of the population, but the entire population to walk through the door. We shouldn't let our professional egos get in the way of thinking how we should run the office. Medicaid, DMO's, HMO's, PPO's... take every single insurances out there and take volume. Some of you will agree, some will hate the idea. But like I said, this is the new normal in orthodontic business....

I've looked up Ben Burris and he is quite the slimebag and says nasty things about GPs. Yeah you can go down that route, but remember once you go down that route, you will get absolutely 0 referrals from GPs for ortho tx

 

[Orthodontist1982]

Okay this is not true. The orthos that work for the corporation I work for make quite a bit, I would venture to say close to 500k annually. And no don't ask me what corporation I work for. But orthos definitely have it made. I curse myself for not going into ortho because my back hurts like hell all the time. To the OP quit your b*tchin, you're in the best dental specialty.

I doubt that, in fact I would guarantee that's not true. There is no chain paying that much to an ortho. They hire for less and work us more because they know they can.

Sounds like OP has no business or networking skills.

The best orthodontists I've known weren't looking for jobs they were looking for markets.

But even barring that, some solid networking would land you a job with a decent chain. I've never met an orthodontist that made less than 250k in the NE, even as an employee.

Then you need to meet more orthodontists. What is your study, n=1?

I've looked up Ben Burris and he is quite the slimebag and says nasty things about GPs. Yeah you can go down that route, but remember once you go down that route, you will get absolutely 0 referrals from GPs for ortho tx

Hey if the GP isn't referring at all, then who cares? Burn all the bridges down. That's where this ship is sailing and it's sailing fast.


Go into ortho, hey I'm all for it. Just remember when you have those dental school dreams of making 500k because someone said they think that sounds right, don't say I told so that you would get crap offers barely pulling 130k working around the clock with more loans than your GP buddies.

 

[johnho771]

I doubt that, in fact I would guarantee that's not true. There is no chain paying that much to an ortho. They hire for less and work us more because they know they can.



Then you need to meet more orthodontists. What is your study, n=1?




Hey if the GP isn't referring at all, then who cares? Burn all the bridges down. That's where this ship is sailing and it's sailing fast.


Go into ortho, hey I'm all for it. Just remember when you have those dental school dreams of making 500k because someone said they think that sounds right, don't say I told so that you would get crap offers barely pulling 130k working around the clock with more loans than your GP buddies.

How are your GP buddies doing now that you graduated with? Are they making decent money, and would you say they are in a better spot than many young orthodontists?

And thanks for sharing. I wish there was more transparency about the career prospects of this field, regarding employment and compensation. With many students taking out 300k-400k+ in loans and then maybe more to specialize, they should be well aware about the prospect of their careers. I know many law and MBA programs publish this data, but there really isn't anything like this for dental.

 

[Orthodontist1982]

How are your GP buddies doing now that you graduated with? Are they making decent money, and would you say they are in a better spot than many young orthodontists?

And thanks for sharing. I wish there was more transparency about the career prospects of this field, regarding employment and compensation. With many students taking out 300k-400k+ in loans and then maybe more to specialize, they should be well aware about the prospect of their careers. I know many law and MBA programs publish this data, but there really isn't anything like this for dental.

GP graduates are in a much better spot than ortho grads. Salaries for associates at like 120-150k, no lost earning potential for residency, and no extra loans. Plus the market now is geared to GPs to take a CE class and start treatment immediately.

 

[comatose]

Dude I'm telling you the orthos that work in this corporation are making BANK. I know this because I'm paid 33 percent of production. I can see my daily numbers as well as the numbers of all the other doctors including the oral surgeons and the orthodontists that work for the company. I doubt they would be paying specialists less than my 33 percent, since orthos are in higher demand than generals. Orthos produce on average 8-12 k per day worked (at the various corporate offices) plus they all work at other private pedo offices as well. Dude you have the easiest dental specialty certificate. Seriously quit your bitchin. Us generals have it way worse than you and our backs are hurting to boot. Good grief get on your antidepressants and get to work like the rest of us!

 

[Silent Cool]

Okay this is not true. The orthos that work for the corporation I work for make quite a bit, I would venture to say close to 500k annually. And no don't ask me what corporation I work for. But orthos definitely have it made. I curse myself for not going into ortho because my back hurts like hell all the time. To the OP quit your b*tchin, you're in the best dental specialty.

For what corporation do you work?

 

[charlestweed]

Orthodontist1982, you can’t find work at private ortho practices because most owner orthodontists, with the help of a couple of assistants, can see 40-80 patients a day. There is really no need for them to hire an associate orthodontist to help out. Another reason why the owner orthodontists are reluctant to hire a new grad is due to the new grad’s lack of experience and difference in tx philosophy. Such lack of experience may ruin the owner orthodontists’ reputation and may cause them to lose the referrals from the GPs. Thus, most of the associate ortho jobs can only be found at busy GP and chain offices. It’s not just ortho….this applies to other dental specialties as well. So here is my message to the students who plan to specialize: don’t expect to get a full time job at one location right after residency. In order to have a full time schedule, the specialists need to travel to different offices. I also had to do travel to different chain offices after I finished my residency in the early 2000s, when things were very good for ortho.

Working at the chain is not as bad as you think. You have the full autonomy. You get to determine which teeth to extract, which appliance to use, and how long the tx will be etc. Unlike private practices, you don’t have to deal with the owner orthodontist, whose tx philosophy may be very different from yours. You are the boss at the chain. The chains also provide you a lot more patients than the private practices. The more patients you treat, the more clinical experiences you will gain. Busy schedules at the chain forces you to work more efficiently….ie bending wires faster, making faster tx decisions, using more efficient mechanics (such as closing loop) to help close extraction spaces faster etc.

Not working enough days is actually a good thing because it forces you to consider starting your own office. Don’t you want to be your own boss? Isn’t this the main reason for spending so many years in school to become an orthodontist? What if the chain that currently employs you files bankruptcy? When you lose your associate job, wouldn’t it be nice if you have your own private practice? The beauty about ortho is you can still keep your P/T associate job while running your own office. The general dentists can’t do this. They have to quit their associate job when they start their own office.

If you only have P/T ortho job and you don’t want to set up your own practice right now, then I think it is a good idea to work P/T as a general dentist. I am very certain that when you work as a general dentist for a while, you will realize doing general dentistry is very hard and you will feel very fortunate to be an orthodontist.

 

[Denticized]

This person is a fraud because of sound evidence which I am about to provide:

1) My friends who just graduated and are currently working in NYC are making twice as much as their GP counter parts. Granted they are working like dogs but they are also making more.

2) # of start-up has only gone down 5% and not the 33% as this person is claiming according to AAO

3) No GP I don't care who they are can tackle a full class II, huge overjet, overbite, or class III case with f#king invisilign unless they are inviting a lawsuit

4) average # of start-up was 230 last year multiplied by 4500 dollars (national average for an ortho case) = well I will let you do the math

5) Please instead of listening to a schmuck do your own research and follow what you like in life. Oh and use some common sense: this guy wants to do fillings instead of braces? I mean come on

 

[Silent Cool]

This person is a fraud because of sound evidence which I am about to provide:

1) My friends who just graduated and are currently working in NYC are making twice as much as their GP counter parts. Granted they are working like dogs but they are also making more.

2) # of start-up has only gone down 5% and not the 33% as this person is claiming according to AAO

3) No GP I don't care who they are can tackle a full class II, huge overjet, overbite, or class III case with f#king invisilign unless they are inviting a lawsuit

4) average # of start-up was 230 last year multiplied by 4500 dollars (national average for an ortho case) = well I will let you do the math

5) Please instead of listening to a schmuck do your own research and follow what you like in life. Oh and use some common sense: this guy wants to do fillings instead of braces? I mean come on

I consider @Shunwei to be the final arbiter of truth on these forums. He understands markets and debt.
Can you corroborate or refute any of this?

thanx

 

[Orthodontist1982]

This person is a fraud because of sound evidence which I am about to provide:

1) My friends who just graduated and are currently working in NYC are making twice as much as their GP counter parts. Granted they are working like dogs but they are also making more.

2) # of start-up has only gone down 5% and not the 33% as this person is claiming according to AAO

3) No GP I don't care who they are can tackle a full class II, huge overjet, overbite, or class III case with f#king invisilign unless they are inviting a lawsuit

4) average # of start-up was 230 last year multiplied by 4500 dollars (national average for an ortho case) = well I will let you do the math

5) Please instead of listening to a schmuck do your own research and follow what you like in life. Oh and use some common sense: this guy wants to do fillings instead of braces? I mean come on

I'll answer your questions since you obviously are pretty upset

1) Uhh yea maybe more per day if we are comparing, but the ortho jobs you see are like 1 day a month. A GP can get 4 days working per week making 400-500 and thr ortho only gets 1 day a month for like 800. So you are making less. It is very very difficult to find as much hours as a GP and you will make less

2) Read my first post, I said production. Production is down 1/3 for ortho offices. You may be increasing your starts, but across the board production is down an average 1/3.

3) yes, and these cases take a long time, and your production per case goes down due to length of the case. The GPs just keep "simple" cases they perceive and don't even refer those out anymore

4) yes that is an average startup # and the average fee for an ortho case but like I said production is decreased and overhead is increased to get these patients into the office. In an ideal world everyone gets 200 starts and charges 6000 a case, but is this an ideal world?

5) don't call me that. I did not say "I want to do fillings, I love general dentistry!" I said if push comes to shove and I have to feed my family I will do it because it's a skill I have. Now go back in your hole

 

[dmacgolf70]

FYI the last time I posted comments like the following I was banned from this site for advertising but I feel it is very important for the future of dentistry and to maintain the trust of the public that dental schools reduce the number of dentist and specialist trained and determine the needs of the public. As a General Dentist in a southeastern capital city who started a practice from scratch in 1985. I have come to the conclusion that there is an oversupply of dentists in most US areas. In 1997 my biggest problem was finding the time to get a patient appointed for and ER and I was booked 2-3 weeks in advance and had 2 FT RDH in 3 operatories. In 2014 with 1 RDH and 4 operatories I may see 2-4 patents on my schedule in addition to checking RDH patients. I have not had a day that I was booked solid since 12/28/2011. I have lost over 1500 patients to PPO's in the last 10 years. Finally in the fall of 2013 with 85% of GP's and 50% of specialists in PPO's I joined 12 PPO's to try and save my practice. That had resulted in a lost of $100,000 in the first 9 months of 2014. At this site (https://sites.google.com/site/dentalmanpowerinwakecounty/home )I have posted my attempt to get involved in solving this problem. Our dental schools, State legislators, dental societies and state boards need to do a better job at determining the number of dentist to train and supervise their conduct ( false advertising, unethical behavior and doing unnecessary treatment just to collect a fee) of the dental community. We need a system to determine the NEEDS by locations. We need a program of certificates of need that makes a hospital justify the need for a new wing. It does not serve the people of the USA to spend the tax dollars to train a dentist who then can not pay back his student loan because they can find full time work.

 

[Firm]

As an orthodontist that has practiced for 8+ years, I agree with everything the OP said. I don't know how a new grad would make it. I'm just lucky that I opened pre-recession and have former patients and some GPs friends who send me patients to rely on. The problem is that there are very few GPs my age who are opening dental offices. Most work in the chains because it's easier money. Once they get into a chain they never refer. The GPs who have opened there own offices are struggling to compete with the chains so they do ortho. The big problem is the illegal chains. They are owned by venture capitalists and not dentists. Once the state dental boards uphold the law that only licensed dentists may own (100%) dental practices, the venture capitalists will run and put their money into something else. When this happens the national chains disappear, GPs have more work to do, they'll do less ortho, the orthos will have more work to do, life is good again.

 

[Silent Cool]

As an orthodontist that has practiced for 8+ years, I agree with everything the OP said. I don't know how a new grad would make it. I'm just lucky that I opened pre-recession and have former patients and some GPs friends who send me patients to rely on. The problem is that there are very few GPs my age who are opening dental offices. Most work in the chains because it's easier money. Once they get into a chain they never refer. The GPs who have opened there own offices are struggling to compete with the chains so they do ortho. The big problem is the illegal chains. They are owned by venture capitalists and not dentists. Once the state dental boards uphold the law that only licensed dentists may own (100%) dental practices, the venture capitalists will run and put their money into something else. When this happens the national chains disappear, GPs have more work to do, they'll do less ortho, the orthos will have more work to do, life is good again.

What if VCs are allowed to keep the chains? I mean they have incredible power and money....

 

[Firm]

What if VCs are allowed to keep the chains? I mean they have incredible power and money....

Might happen but there are already laws going through statehouses to ban them. The VC have stopped building offices in North Carolina until the case there is settled. Dental offices aren't like McDonalds were they are easily duplicated. There are a lot of problems with chains, just look at the Aspen complaints.

 

[Typo]

Ortho can still be great, but it isn't automatic. You definitely have to approach it like a business. The beauty of ortho over other specialties is that you can advertise directly to the public, and can build a practice based on patient to friend referral, internet, direct mail, and other advertising mediums. This simply can't be done with endo, perio, and arguably OMS (except for implants). My practice has grown 25-30% each year over the past two years by taking this approach, and working to get off the referral gravy train.

By the way - Burris doesn't care about dentist referrals, he doesn't need them. His practice has graduated from kissing hiney.

 

[charlestweed]

I too agree that not having to rely 100% on the GP referrals is what makes ortho the best specialty in dentistry. Without referrals from the GPs, the perio/endo/omfs practices cannot survive. IMO, orthodontics is in much better shape than other dental specialties. 99.999% of the GPs do their own RCTs and only refer difficult second molar cases with curved calcified roots to the endodontists. The high implant success rate further threatens the endo specialty. Many GPs extract 3rd molars as well. The oral surgeons have to compete with the periodontists for patients because both specialties handle similar procedures such as implants, canine exposures, bone grafts etc. GPs rarely refer patients to prosth. Pedo will also face over saturation problem in the future because of the openings of many new pedo residency programs.

Another advantage that ortho has over other dental specialties is the patients don’t have to pay the whole amount up-front like they would with dental implants, molar endo, or 3rd molar extractions etc. To start ortho tx, the ortho patients only have to put down a small amount and then they can make monthly payments with 0% interest. With affordable payment plans in ortho, ortho treatments are no longer just for wealthy kids. Everyone deserves to have a beautiful smile. As long as the population continues to grow (from increased birthrate + immigration), ortho specialty will never die.

 

[nyc4lyfe]

I too agree that not having to rely 100% on the GP referrals is what makes ortho the best specialty in dentistry. Without referrals from the GPs, the perio/endo/omfs practices cannot survive. IMO, orthodontics is in much better shape than other dental specialties. 99.999% of the GPs do their own RCTs and only refer difficult second molar cases with curved calcified roots to the endodontists. The high implant success rate further threatens the endo specialty. Many GPs extract 3rd molars as well. The oral surgeons have to compete with the periodontists for patients because both specialties handle similar procedures such as implants, canine exposures, bone grafts etc. GPs rarely refer patients to prosth. Pedo will also face over saturation problem in the future because of the openings of many new pedo residency programs.

Another advantage that ortho has over other dental specialties is the patients don’t have to pay the whole amount up-front like they would with dental implants, molar endo, or 3rd molar extractions etc. To start ortho tx, the ortho patients only have to put down a small amount and then they can make monthly payments with 0% interest. With affordable payment plans in ortho, ortho treatments are no longer just for wealthy kids. Everyone deserves to have a beautiful smile. As long as the population continues to grow (from increased birthrate + immigration), ortho specialty will never die.

Right but for some reason you're also completely ignoring the fact that GPs do Invisalign, Six Month smiles, etc. As technology gets better and as GPs get more hungry they can enroach on Ortho (not being negative, but just saying) Affordable payments exist for a lot of dental procedures and aren't the main reason why ortho exists, its exists because mommy wants junior to have that winning smile so she's willing to pay 5k. I particularly think Ortho is winning by default, a recent dentaltown survey found that majority of GPs don't do Ortho because they find no interest in it (I share this opinion.) I also think its too soon to call Pedo oversaturated, Ortho programs have been opening up left and right for a long time and if Ortho is not oversatured yet, I don't think Pedo is either.

Just my 2 cents. Any program should be entered in with the thought of enjoying doing the same thing over and over again. That's why GPR is king to me because you're never locked into anything. Going into any specialty for the money will always lead to disappointment, also there are much easier ways to make $$$ than dentistry or even a dental specialty.

 

[OG1]

With affordable payment plans in ortho, ortho treatments are no longer just for wealthy kids.

Bingo! This is a major trump card for ortho. Big ticket item that most parents want for their child, and you can finance it. It is much lower risk than financing dental work since dental work is one and done, or only a few appointments and done. Ortho is extended over time so you can spread payments out and your risk of getting burned is lower if you are rigorous in your collections and ensuring that you aren't continuing treatment past 90 days on those who refuse to pay their bill. This is why it is almost pointless to offer care credit in ortho - you can finance it yourself and most everyone pays their bills.

Ortho being practiced by GPs should be fought by educating the public aggressively about the difference between an orthodontist vs. general dentist. Six Month Smiles and all the other variations of short term ortho are not meant for comprehensive treatment, since comprehensive treatment requires problem solving on an appointment by appointment basis. The major risk is the public's lack of education; I think most don't know that orthodontists actually went to dental school and generally performed very well in school, and most don't have a clue what a quality ortho result looks like.

 

[charlestweed]

Right but for some reason you're also completely ignoring the fact that GPs do Invisalign, Six Month smiles, etc. As technology gets better and as GPs get more hungry they can enroach on Ortho (not being negative, but just saying) Affordable payments exist for a lot of dental procedures and aren't the main reason why ortho exists, its exists because mommy wants junior to have that winning smile so she's willing to pay 5k. I particularly think Ortho is winning by default, a recent dentaltown survey found that majority of GPs don't do Ortho because they find no interest in it (I share this opinion.) I also think its too soon to call Pedo oversaturated, Ortho programs have been opening up left and right for a long time and if Ortho is not oversatured yet, I don't think Pedo is either.

Just my 2 cents. Any program should be entered in with the thought of enjoying doing the same thing over and over again. That's why GPR is king to me because you're never locked into anything. Going into any specialty for the money will always lead to disappointment, also there are much easier ways to make $$$ than dentistry or even a dental specialty.

Oh, I am well aware of the fact that Invisalign and ortho supply companies have sold their products to more GPs than to orthodontists. Better technology may help more GPs handle difficult endo tx but better technology does not necessarily help more GPs perform ortho tx in their practices. Why? Because technology cannot replace the doctor’s ability to diagnose and tx plan the orthodontic problems. Diagnosis and tx planning are essential parts of ortho treatments. And such ability can only be acquired through a formal residency training and from treating a lot of a lot of cases day in and day out. I think the GPs’ lack of experience in ortho tx planning is the reason why the recent orthotown survey showed the majority of GPs don’t do ortho in their practices. Another reason the GPs don’t do ortho is they have to do most of the manual labors by themselves (because most or their dental assistants are clueless about ortho). More doctor’s time = less profitability.

If more and more GPs start doing ortho, then we, orthodontists, would see fewer easy class I malocclusion cases and only deal with complex ortho cases, right? That’s not the trend I see. At my practices, many of my cases are simple 12-18 month cases. It’s the affordable interest free payment plan in ortho that helps the orthodontists get more patients without relying too much on the GP referrals. What prevents many patients from getting Invisalign tx is the required high down payment amount to cover the high lab fee.

 

[nyc4lyfe]

Oh, I am well aware of the fact that Invisalign and ortho supply companies have sold their products to more GPs than to orthodontists. Better technology may help more GPs handle difficult endo tx but better technology does not necessarily help more GPs perform ortho tx in their practices. Why? Because technology cannot replace the doctor’s ability to diagnose and tx plan the orthodontic problems. Diagnosis and tx planning are essential parts of ortho treatments. And such ability can only be acquired through a formal residency training and from treating a lot of a lot of cases day in and day out. I think the GPs’ lack of experience in ortho tx planning is the reason why the recent orthotown survey showed the majority of GPs don’t do ortho in their practices. Another reason the GPs don’t do ortho is they have to do most of the manual labors by themselves (because most or their dental assistants are clueless about ortho). More doctor’s time = less profitability.

If more and more GPs start doing ortho, then we, orthodontists, would see fewer easy class I malocclusion cases and only deal with complex ortho cases, right? That’s not the trend I see. At my practices, many of my cases are simple 12-18 month cases. It’s the affordable interest free payment plan in ortho that helps the orthodontists get more patients without relying too much on the GP referrals. What prevents many patients from getting Invisalign tx is the required high down payment amount to cover the high lab fee.

The specialty argument can be used for anything really i.e OMFS should always be in charge of pulling 3rds. I think there's just a general lack of interest in ortho by GPs. Enough CE will teach you anything you want or need if you take the time to really learn it and apply yourself. I think as a GP you can make more $$$ faster and easier than trying to learn Ortho. But if you really wanted to, you can do ortho as a GP, not on the same caliber as an Orthodontist but enough to make a decent scratch from it.

My main issue with any specialty is the repetitive nature. (OMFS excluded) Doing the same all day every day, including bending wires isn't my cup of tea. Just saying.

 

[sed8nyank4u]

wah wah wah.... that is my response to the op. Buck up and get to work. It sounds like you are going through the same realization many new docs go through shortly after finishing school. "You mean I have to WORK for it? You mean I might have to think outside the box and maybe even lose some stomach lining?"
GPs are not going to quit doing procedures that specialists also do unless they don't like them.
I am trained in Invisalign, Clear Correct, Fast Braces and yes I cherry pick only the easiest cases. I don't really like it but my patients want it done conveniently where they are comfortable.
Why don't you consider opening Saturday? Oh, and another problem you are fighting: Orthodontists don't retire, they die.

 

[sed8nyank4u]

How about open past five? You would make a killing. In fact, If I were an ortho, I would only be open early am, evenings, and weekends.

 

[Firm]

How about open past five? You would make a killing. In fact, If I were an ortho, I would only be open early am, evenings, and weekends.

The ortho staff that you would have in an office that is open past 5 and on the weekends would be young and inexperienced. In addition, the public expects you to be "open" 8-5 M-F to answer phones at least. If you start extending hours into the weekend and evening, you either go over 40 hours in payroll (time and a half) or you have to hire part-time staff which will be unreliable at best. I'm not busy enough for 25 hours/week let alone 50+ hours/week. I would like to change my schedule to 2-7pm three days a week and 1 saturday morning every 2 months but my staff would all quit and they are pretty good with patients.

 

[charlestweed]

How about open past five? You would make a killing. In fact, If I were an ortho, I would only be open early am, evenings, and weekends.

That's what I did when I started my first office 9 years ago. I didn't want to quit my associate job. Therefore, right after I finished my associate job at 6pm, I drove straight to my own office and saw patients from 6:30pm-9pm. I asked one of the chain's assistants to follow me to my office and I paid her $50 for helping me. My wife also helped me.

My colleagues felt sorry for me when they saw me working so late. I, on the other hand, felt extremely happy because my new office actually had patients for me to treat. My patients paid me much lower fee (compared to other ortho offices) but I still treat them like kings and queens because I want them to go around telling others about me. To me, it's more depressing to sit around doing nothing and still have to pay bills. About a year and a half later, I stopped offering late night hours. Now, I only work from 2pm - 6pm.

 

[Lyoness]

Even if GP's provide ortho treatments, people will always come back to the specialists.

 

[Silent Cool]

Alright Ortho haters, I found this practice for sale on Dentaltown. The owner is taking home a motherload.
Would any of you in the market care to comment on this?

Thanks

http://www.dentaltown.com/dentaltown/ClassifiedAds.aspx?action=DETAILS&aid=74571

 

[Firm]

Alright Ortho haters, I found this practice for sale on Dentaltown. The owner is taking home a motherload.
Would any of you in the market care to comment on this?

Thanks

http://www.dentaltown.com/dentaltown/ClassifiedAds.aspx?action=DETAILS&aid=74571

Assuming that the numbers are correct, why would he leave that to stay on as an associate? Mega-practices are doctor/owner dependent. Usually they are built by orthodontists with great connections, personality, the ability to dominate the referral game and lack of competition. As soon as you purchase that practice (or any other practice) those things change immediately. Typically there is a 2nd or 3rd person in the area waiting to take over this top dogs spot. I've seen so many examples of young docs buying these awesome $1-3 million practices only to have long time staff leave, referrals dry up and existing patients not refer. The young doc is left scrambling to open a satellite or work part time for a corporation in order to pay for the bank loan on this practice.

 

[Orthodontist1982]

Assuming that the numbers are correct, why would he leave that to stay on as an associate? Mega-practices are doctor/owner dependent. Usually they are built by orthodontists with great connections, personality, the ability to dominate the referral game and lack of competition. As soon as you purchase that practice (or any other practice) those things change immediately. Typically there is a 2nd or 3rd person in the area waiting to take over this top dogs spot. I've seen so many examples of young docs buying these awesome $1-3 million practices only to have long time staff leave, referrals dry up and existing patients not refer. The young doc is left scrambling to open a satellite or work part time for a corporation in order to pay for the bank loan on this practice.

Best you can do is do a startup and accept the fact your GP buddies are gonna make more than you

 

[Firm]

Best you can do is do a startup and accept the fact your GP buddies are gonna make more than you

Startups are worse, stay away. A good value existing practice is the way to go. One where the owner may be sick, needs to get out quick or hasn't taken care of it the past few years. Kinda like buying a house, you don't want to buy at the top of the market.

 

[656851]

Generally speaking, how much of an orthodontist's patients come from referrals and how much from direct marketing? I guess it depends on practice to practice, but is there a typical amount? Are there orthos who get by without any referras?

 

[Firm]

Generally speaking, how much of an orthodontist's patients come from referrals and how much from direct marketing? I guess it depends on practice to practice, but is there a typical amount? Are there orthos who get by without any referras?

Depends on the age of the practice. A newer practice will rely on direct marketing. An older practice, more referral marketing. These days less GPs are referring procedures out, many would rather make zero profit off a procedure rather than have the patient go to another office. Invisalign, 6MS, STO has created less referrals. Also, less GPs are entering private practice choosing to go the corporate route. No procedure leaves the corporation.
Direct marketing has its challenges too, namely cost. You have to purchase advertisement, offer a deal, then you'll attract the cheapest people looking for the lowest price, which you can never be.

 

[656851]

Depends on the age of the practice. A newer practice will rely on direct marketing. An older practice, more referral marketing. These days less GPs are referring procedures out, many would rather make zero profit off a procedure rather than have the patient go to another office. Invisalign, 6MS, STO has created less referrals. Also, less GPs are entering private practice choosing to go the corporate route. No procedure leaves the corporation.
Direct marketing has its challenges too, namely cost. You have to purchase advertisement, offer a deal, then you'll attract the cheapest people looking for the lowest price, which you can never be.

Ok, that makes sense. So, in this increasingly difficult environment, these discussions seem to suggest two things orthodontists can do to make it these days (besides being charming and lucky):

1) have an alternative practice style. That is, be open after hours, be a traveling specialist, try to be the cheap option, etc...
2) or go rural.

To the second point, are there really still 'underserved' orthodontic populations left, in a geographic sense? I mean doing the math, it seems the orthodontist population will increase almost 20% in the next 6 years alone. And just the other day I was driving through a rural part of Alabama to visit family, and in the middle of bum f**k nowhere, surrounded by farms, there was a stylish little cottage with a spiffy graphically-designed "Orthodontist" sign out front.

When people say 'go rural' are we talking Wyoming rural?

 

[charlestweed]

Generally speaking, how much of an orthodontist's patients come from referrals and how much from direct marketing? I guess it depends on practice to practice, but is there a typical amount? Are there orthos who get by without any referras?

Sure, many of us, orthodontists, can get by without any GP referrals but to get to this point we have to be in our practices for a couple of years and have a good track record of providing excellent care. Most patients want high quality work and affordable fees. If your fees are cheap but you do poor orthodontic work, then don’t expect to see a lot of patients to come to see you. So how do you get the point where you no longer need the GP referrals? The very simple answer is by starting as many new cases as possible. The more cases you treat and finish, the more people will go around saying nice things about you. To start as many new cases as possible, you’ll need to do the following when you start your practice:

-Going door to door to beg the GPs for referrals. Many of the GPs may not be very happy with the orthodontists they've referred to and they might want to try your office.

-Charge reasonable fees to increase case acceptance. If the GPs refer a bunch of patients to you but none of them accept the tx because of your high fees, then the GPs will have to refer their patients to other orthos who charge lower fees. To accomplish this, you need to keep the overhead low. Fortunately, ortho is the specialty that has lowest overhead.

-Hire friendly staff to treat the patients well. To me, that’s more important than spending a ton of money on high tech equipments and office décor.

-Open your office on the weekends and late hours. Most patients are kids and their parents don’t want them to miss school.

-Welcome every patient to your office even if the patients just want to shop around for the best price. Who know? The patients may like you because of your friendly personality.

-Accept as many insurance plan as possible even if they don't pay you a lot.

-Target the populations that most orthodontists largely ignore such as low income Hispanic and Asian populations. It’s a mistake to assume that the patients are too poor to afford ortho tx by looking at what they wear and drive. High income parents also fail to make payments on time because there are so many other expenses for them to worry about as well…such as BMW car payments, private school tuitions for their kids etc.

If you do all of these above, you don't have to go rural areas. You can have a successful ortho practice right here in Southern California. People in big cities care more about having beautiful smiles and want braces for their kids than people who live in rural areas. There are also more referring GPs in big cities than in rural areas.

 

[656851]

Sure, many of us, orthodontists, can get by without any GP referrals but to get to this point we have to be in our practices for a couple of years and have a good track record of providing excellent care. Most patients want high quality work and affordable fees. If your fees are cheap but you do poor orthodontic work, then don’t expect to see a lot of patients to come to see you. So how do you get the point where you no longer need the GP referrals? The very simple answer is by starting as many new cases as possible. The more cases you treat and finish, the more people will go around saying nice things about you. To start as many new cases as possible, you’ll need to do the following when you start your practice:

-Going door to door to beg the GPs for referrals. Many of the GPs may not be very happy with the orthodontists they've referred to and they might want to try your office.

-Charge reasonable fees to increase case acceptance. If the GPs refer a bunch of patients to you but none of them accept the tx because of your high fees, then the GPs will have to refer their patients to other orthos who charge lower fees. To accomplish this, you need to keep the overhead low. Fortunately, ortho is the specialty that has lowest overhead.

-Hire friendly staff to treat the patients well. To me, that’s more important than spending a ton of money on high tech equipments and office décor.

-Open your office on the weekends and late hours. Most patients are kids and their parents don’t want them to miss school.

-Welcome every patient to your office even if the patients just want to shop around for the best price. Who know? The patients may like you because of your friendly personality.

-Accept as many insurance plan as possible even if they don't pay you a lot.

-Target the populations that most orthodontists largely ignore such as low income Hispanic and Asian populations. It’s a mistake to assume that the patients are too poor to afford ortho tx by looking at what they wear and drive. High income parents also fail to make payments on time because there are so many other expenses for them to worry about as well…such as BMW car payments, private school tuitions for their kids etc.

If you do all of these above, you don't have to go rural areas. You can have a successful ortho practice right here in Southern California. People in big cities care more about having beautiful smiles and want braces for their kids than people who live in rural areas. There are also more referring GPs in big cities than in rural areas.

Thanks for response. Seems to be a good distillation of some other things I've read of yours.

 

[Solostr8]

Why do you think the general dentists are doing so much orthodontics? Of course part of it has to do with making a living in an economy that isn't strong. But I invite you all to think about what we have done to our profession in terms of how we treat patients. If everything is straight wire, prefabricated, cad/cam and automatized... we have sent a message that as long as we are using the "most advanced technology available", that orthodontics is really simple, mostly delegated to auxiliaries, or easy because we use a particular type of bracket, robotics, or software.
WAKE UP FROM your pleasant dream of entitlement which started the day your foot landed in dental school. If this is how we're practicing ,and this is what we reduced our specialty to, then why the hell would general dentists refer out any orthodontics? I sure wouldn't. In my opinion, the orthodontists who market their practices according to products that they are using are no better than the general dentists doing the exact same thing with their Fast Braces ™ or six month smiles. So really I think we as specialists have devalued our own specialty by buying into this type of thinking and hype. I can't remember the last time I finished a case without bending any wire. Maybe that means I can't put brackets on teeth worth a crap.... But I really don't think it's that. I feel good about the finishes that I provide for my patients even though they don't know the difference.... But hey, that's our job isn't it. And yeah I'd love to be making five to seven hundred thousand dollars a year...but you know what? I am just fine with making 200 to 300. And by the way...all of you who are thinking of owning your practice, especially if you purchasing the practice, need to educate yourselves on the tax implications of buying an existing practice with a loan. This is especially true if you live in a state with an overall high tax rate ( California Hawaii Minnesota). You'll be quite surprised at the amount of taxes you'll be paying....completely insane.... Unless you are making 350 or more you're going to have a hard time paying your bills living comfortably and making those tax payments. Those of you getting a paycheck from a corporation or as an employee take this for granted... If you purchase a practice and make the exact same amount of money you're making now,you're going to be taking home significanfly less (35 percent for me) due to the huge additional tax obligation... That $8000 a month payment that you're making for your debt service for your business is pretty much taxable except for the interest..... And that number on your income tax return is never even close to what you're really taking home its far less. Before you buy a practice make sure you have a working and employed spouse and you understand what the short and long term tax obligations will be... Not one person in my acquisition process explained any of this to me, and I'm finding out now after owning my practice since 2006 why it's so hard to pay my taxes. I'm not complaining about my income, but I sure don't like giving it all to the government. Believe me, I was perfectly fine paying taxes as an associate making $250,000 a year... but when you make that as an owner it's a whole different ballgame. For me this is the biggest thing that I personally struggle with. I figured out a long time ago that my expectations were completely unrealistic, partly thanks to the people who educated me to have no idea what it's really like out in the real world, But also due to my own sense of entitlement, which I acquired on my own over the years.
But I think as a profession we really need to focus on doing top quality orthodontics because that's essentially what should be setting us apart from the general dentists . Using a specific bracket or product, subscribing to a certain treatment philosophy, or incorporating cad/cam bracket and archwire systems does not make you a good orthodontist. Is the technology cool and interesting ...absolutely. Can the technology help us treat patients more efficiently? I believe it can. But you know what? Anybody with a dental license can use it. Here is a crude example: I could go out and buy a $300 pair of designer jeans, but if my butt is out of shape or flat, it still isn't going to look good. I could boast that my butt is sexy because pulled on a $300 pair of designer jeans. Or I could work out and build that great butt with hard work. My rear would look great in a pair of Levis, and I wouldn't have to tell people about my great butt looks...because they would notice it. When it's all said and done, a good finish is going to look good not because of what kind of bracket or technology you used, but rather how much time and energy you spend. I'm not saying that we should be inefficient and antiquated, but I am suggesting that we get back to the basics, and stop kidding ourselves with the BS. It seems like we're good at believing the BS as long as it means making more money. But if we want to continue being a specialty then we need to set ourselves apart. That is what will save the specialty. But that will only happen if our specialty members collectively believe in and practice with this philosophy. It isn't all about doing things the quick and easy way. And if you say "that's what the public wants so that's what we should give them".... then do me a favor and stop complaining that the general dentists are doing the all ortho. They're doing it because you devalued the service you provide as a specialist. Of course this is just my opinion and I could be completely wrong.... Guess we'll find out in the future.

 

[Solostr8]

Startups are worse, stay away. A good value existing practice is the way to go. One where the owner may be sick, needs to get out quick or hasn't taken care of it the past few years. Kinda like buying a house, you don't want to buy at the top of the market.

Ahhhh...but have you considered the tax burden you will be under when buying an existing practice using a bank loan....depending on the price of the practice and how it is allocated, and amortized you will be looking at quite an additional tax burden compared to when you were just an employee making the same amount. that starts to become more apparent say in the third fourth fifth year from when you bought the practice. taxable income may be 200 thousand but you'll be paying over $70,000 just in federal taxes....as an employee when I made the same amount I paid about 45 thousand in federal taxes. clusters payroll taxes and then my state at there's also a tax on all services provided of tothere's also an employment tax and sales tax for things told such as fluoride or if you're making $400,000 or more if really affect you but if you're making 200,000 it will definitely affect you.

Startups are worse, stay away. A good value existing practice is the way to go. One where the owner may be sick, needs to get out quick or hasn't taken care of it the past few years. Kinda like buying a house, you don't want to buy at the top of the market.

Startups are worse, stay away. A good value existing practice is the way to go. One where the owner may be sick, needs to get out quick or hasn't taken care of it the past few years. Kinda like buying a house, you don't want to buy at the top of the market.

 

[Solostr8]

Orthodontist1982, you can’t find work at private ortho practices because most owner orthodontists, with the help of a couple of assistants, can see 40-80 patients a day. There is really no need for them to hire an associate orthodontist to help out. Another reason why the owner orthodontists are reluctant to hire a new grad is due to the new grad’s lack of experience and difference in tx philosophy. Such lack of experience may ruin the owner orthodontists’ reputation and may cause them to lose the referrals from the GPs. Thus, most of the associate ortho jobs can only be found at busy GP and chain offices. It’s not just ortho….this applies to other dental specialties as well. So here is my message to the students who plan to specialize: don’t expect to get a full time job at one location right after residency. In order to have a full time schedule, the specialists need to travel to different offices. I also had to do travel to different chain offices after I finished my residency in the early 2000s, when things were very good for ortho.

Working at the chain is not as bad as you think. You have the full autonomy. You get to determine which teeth to extract, which appliance to use, and how long the tx will be etc. Unlike private practices, you don’t have to deal with the owner orthodontist, whose tx philosophy may be very different from yours. You are the boss at the chain. The chains also provide you a lot more patients than the private practices. The more patients you treat, the more clinical experiences you will gain. Busy schedules at the chain forces you to work more efficiently….ie bending wires faster, making faster tx decisions, using more efficient mechanics (such as closing loop) to help close extraction spaces faster etc.

Not working enough days is actually a good thing because it forces you to consider starting your own office. Don’t you want to be your own boss? Isn’t this the main reason for spending so many years in school to become an orthodontist? What if the chain that currently employs you files bankruptcy? When you lose your associate job, wouldn’t it be nice if you have your own private practice? The beauty about ortho is you can still keep your P/T associate job while running your own office. The general dentists can’t do this. They have to quit their associate job when they start their own office.

If you only have P/T ortho job and you don’t want to set up your own practice right now, then I think it is a good idea to work P/T as a general dentist. I am very certain that when you work as a general dentist for a while, you will realize doing general dentistry is very hard and you will feel very fortunate to be an orthodontist.

I think now it just has to do with dollars and cents in terms of why owner orthodontistists aren't looking for associates as much as they were in the past...But eventually, they will be...and because they're waiting longer their practices will be past their peak growth and little bit less expensive to purchase plus the seller will be more motivated because he or she will be much older so hang in there! The real question is are owner orthos looking to sell their practice or sell a %of their practice? are they willing to demonstrate that they are indeed serious about this and are they willing to initiate a plan and terms for this transition, as well as a timerframe of when it is going to occur...if you find a situation like that jump on it. my experience is the orthodontist thanks his practice isn't busy enough when in fact it isn't and experiences a decrease in incomebut not necessarily an increase in production unless they are lucky. there's no practice is busy enough to take on another associate without a resultant decrease in income for the owner. if the owner does not accept this then the owner is not ready to have an associate in my opinion. sometimes this works out really well and it's a win win but usually somebody is going to get a decrease in their paycheck and it's going to be the owner