The future of dentistry

[Scumbag_Steve]

.

---

Members don't see this ad.

 

[fancymylotus]

I have a few quick questions.

So you mentioned how it makes sense for you to refer patients out to specialists when you're not comfortable doing the procedure, and you take issue with CE warriors claiming proficiency in procedures that other people go to years of residency to do. The general dentist I shadowed shares much of the same feelings. She think's it's just better to focus on the restorative and aesthetic stuff that's her jam. I only saw her do like two extractions and one root canal in the 110 hours I observed her.

My question is what do you think the balance is between dentists that practice like you and the one I shadowed vs CE warriors? Do you think it is any different in your region of the country than others? Do you think there is any substance in the argument that specialists are suffering/will soon suffer from the encroachment of GPs? Just your general thought on this whole thing, because you obviously have a better idea than pre-dents.

Also, I'm interested in how your multi-specialty practice works in the dynamic and politics of referrals. Do you ever refer to other specialists not in the group? I have a preliminary interest in specializing, and I feel like I would hate the business owning aspect of it so much that I would be glad to work in a multi-specialty or as an associate for another doc to not have to hire/fire people. I think I have a good personality and work ethic that would do well with private practice (i.e. I'm not socially awkward or looking for a job where I go in, spend 8 hours and leave without caring about what happens to the practice), I'm just a non-confrontational person and don't want to have to deal with embezzlement/stealing narcotics/firing people, that whole mess.

Thoughts on any of this or expansions into other thoughts would be welcome. Thanks again!

I think that specialists who work by themselves and run solely off of referrals and word of mouth will suffer the most. And this is really most of the specialists out there. Most people, GP or specialist, have nearly zero idea how to run a business. This is a large part of the reason, besides GP's taking CE's and doing specialty work at a lower cost, that stand alone specialist practices probably wont be doing so well in the long run. Only people I can see maybe not hurting because of this is OMFS, but even then, my patients appreciate me not having to send them off for wisdom teeth extractions when I can have our surgeon do it. So its changing for everyone.

We dont refer out for anything. But thats just because of our set up.

If you feel that the business aspect isnt something you would enjoy, do what my associates do, and work in a group like ours. We take care of most of the background work for them, we even treatment plan cases for them, and then hand them off. I know what I'm good at---- coming up with plans, figuring out what my patients need and how to financially make it work for them---why bother trying to be a hero and do a procedure I dont want? I'd rather let someone else do it. But there is a lot of background businesswork involved in this, and I cant repeat it enough, running a business is way more of a headache than most patient issues, so if its not something youre sure of, dont do it. You'll get disillusioned and grouchy pretty quickly.

 

[480640]

.

 

[fancymylotus]

Are the specialists in your practice working full time JUST with the in-house referrals?

And could you elaborate on why exactly OMFS will be the specialty less prone to be hurt by the changing dynamics?

I apologize if it'll make you be redundant, it's just that I don't quite know how the multi specialty practice business model is.

No, they are not full time with us. They have patients that they see who do not see us first, new consults, etc etc as well. Just the large treatment plan patients who we see first, are the ones that get "referred" to them by us

From what I can tell, the omfs around us are primarily based on the volume of teeth they extract, especially wisdom teeth, which is why I don't see them being hurt immediately as much. But I can tell you for sure that the number of implants they're placing or apicos they're doing has gone down.


Sent from my iPhone using SDN mobile app

 

[Scumbag_Steve]

.

 

[ph159]

Some one please ban this topic from ever arising again on this forum.

 

[fancymylotus]

Thanks so much. I hope you stick around many years for when the **** I'm prematurely worrying about actually becomes relevant.

If I ever disappear, ill leave an email address for questions


Sent from my iPhone using SDN mobile app

 

[hellofuturedentists]

Some one please ban this topic from ever arising again on this forum.

Lol I have a few more topics to add to that banned list...Some people just refuse to use the search function

 

[DocVaquero]

@fancymylotus gracing us with all her wisdom

 

[fancymylotus]

@fancymylotus gracing us with all her wisdom

I know where you live little one!!!


Sent from my iPhone using SDN mobile app

 

[fancymylotus]

Just for reference, the number of absolutely stupid things the girls managed to do today caused me to almost (mentally) punch a wall...then I calmed myself down by eating the go gurt that came with my panera kids meal


Sent from my iPhone using SDN mobile app

 

[Apramana]

If I ever disappear, ill leave an email address for questions

Sent from my iPhone using SDN mobile app

Thanks so much for taking the time to address our questions, @fancymylotus, and for being willing to make yourself available for them in the future.

I think your actions definitely embody the type of compassionate, professional mentor that helps make SDN the amazing resource that it is, and I definitely hope to give back to our community in a similar fashion. Thanks for setting an excellent example for the rest of us, and please keep up the great work

I'm glad that you seem to continue to find the practice of dentistry very fulfilling, and extremely grateful that you're kind enough to help us as we work to attain a similar level of professional satisfaction.

I hope you and everyone else reading this are having an amazing day

 

[allantois]

I don't mean to be negative, but I think a better question to ask @fancymylotus would be how much they pay their other GPs at her dad's office.

Otherwise, I think a career in dentistry is a no-brainer for someone who has a parent with an established dental practice.

 

[fancymylotus]

I don't mean to be negative, but I think a better question to ask @fancymylotus would be how much they pay their other GPs at her dad's office.

Otherwise, I think a career in dentistry is a no-brainer for someone who has a parent with an established dental practice.

I'm the only GP.

And I agree, this was a no brainer for me over medicine. I like the business aspect, and I had a business waiting for me.

Doesn't mean that I can't share the things I've learned.


Sent from my iPhone using SDN mobile app

 

[Cranjis McBasketball]

I'm the only GP.

And I agree, this was a no brainer for me over medicine. I like the business aspect, and I had a business waiting for me.

Doesn't mean that I can't share the things I've learned.


Sent from my iPhone using SDN mobile app

Is it true that midwest and some areas in the country are in a high demand for dentists? Or has almost every market become saturated by now?

 

[Scumbag_Steve]

.

 

[fancymylotus]

Is it true that midwest and some areas in the country are in a high demand for dentists? Or has almost every market become saturated by now?

Lots of unsaturated markets, but not necessarily in "desirable" areas. And many people want to stay near family, near large metro areas, etc, and these tend to be more saturated.

 

[Apramana]

Is it true that midwest and some areas in the country are in a high demand for dentists? Or has almost every market become saturated by now?

Fancy is more knowledgeable than I am but even I can tell you that there unsaturated markets aplenty in this country.

BLS records on median wages by area might be helpful, and they can be tracked back through each annual publication to determine if there are any trends.

Here's the current data for general dentists:
http://www.bls.gov/oes/current/oes291021.htm

By looking at the BLS data, getting a sense of cost of living in these areas, and determining the business and income tax situations in any given area, it seems we can obtain a fairly accurate picture of what a practice region may produce, especially for an owner dentist.

We can also look at shortage areas for dentistry across the nation to determine where the unsaturated, high need areas are:
http://www.hrsa.gov/shortage/

However, I would think that once a larger supply of dentists descends on a high median wage area, the shortage-inflated salaries will quickly drop.

@cabinbuilder has posted extensively about her experiences leading a successful career as a locum doctor, and I would think similar opportunities would exist for locum dentists.

https://en.wikipedia.org/wiki/Locum

Locum work could also help dentists identify areas of dental need, and evaluate whether or not they are areas worth permanently working or opening up a private practice in.

However, as @Law2Doc has shared, in his previous career as a lawyer he worked extensively with medical practice bankruptcy cases, where previously unopposed practices; especially cash-only, concierge practices; quickly went out of business as soon as a single competitor entered the market. The two competing practices would continue to try to undercut the competition through lowering prices, until collections were no longer enough to remain in business.

Ownership and health professional practice can definitely be challenging, but there are quite a few resources on SDN to help us navigate the waters, thanks to the many who have been willing to share their knowledge and experiences with the rest of us.

I hope you find the resources, especially the ones I mentioned, at least as worthwhile as I have Please have a great day.

 

[romoxx23]

I think the future depends on ourselves.
I would suggest buying and reading this. It'll help give perspective on what amazing things can happen in dentistry don't let others get you down.

Amazon product

 

[Incis0r]

I think the future depends on ourselves.
I would suggest buying and reading this. It'll help give perspective on what amazing things can happen in dentistry don't let others get you down.

Amazon product

The author of that book (Tuan) created the DentalMaverick course. GREAT guy. Knows a lot. I second the recommendation to check his book out.

 

[Dentalnerdz]

I try to avoid these doom and gloom threads as much possible, but I'm killing time at work and just read the two most depressing studies from the ADA health policy institute:

http://www.ada.org/~/media/ADA/Science and Research/HPI/Files/HPIBrief_1215_1.pdf?la=en

http://www.ada.org/~/media/ADA/Science and Research/HPI/Files/HPIBrief_1014_1.ashx

Stuff like this I take seriously unlike some of the ranting people do on here with no actual facts... This is actually pretty scary.

Basically the first reinforces that wages are going down and will likely continue to go down, and the second reinforces that over saturation is a severe issue that is also only getting worse.

Gonna go cry over my acceptance letter now...

 

[Incis0r]

I try to avoid these doom and gloom threads as much possible, but I'm killing time at work and just read the two most depressing studies from the ADA health policy institute:

http://www.ada.org/~/media/ADA/Science and Research/HPI/Files/HPIBrief_1215_1.pdf?la=en

http://www.ada.org/~/media/ADA/Science and Research/HPI/Files/HPIBrief_1014_1.ashx

Stuff like this I take seriously unlike some of the ranting people do on here with no actual facts... This is actually pretty scary.

Basically the first reinforces that wages are going down and will likely continue to go down, and the second reinforces that over saturation is a severe issue that is also only getting worse.

Gonna go cry over my acceptance letter now...

Good food for thought. Thanks for the share!

 

[Cranjis McBasketball]

Honestly, since the 1970's dentists have said the glory days are over. It'll never be a bad profession. It is always gonna be better than 95% of other careers out there. If dentistry suffers it usually means that most other jobs are suffering.

 

[Incis0r]

Honestly, since the 1970's dentists have said the glory days are over. It'll never be a bad profession. It is always gonna be better than 95% of other careers out there. If dentistry suffers it usually means that most other jobs are suffering.

I agree that it'll never be a bad profession.

The issue is that in the 1970s, dental school costed $15,000 a year. After adjusting for inflation, that's about $70,000/yr in today's dollars.

But many private schools are charging $100,000+/yr. USC's first year is above $130K now. Just for 1 year. So the debt to income ratio is rising.

Now, that may not be a serious issue by itself, but when you consider various other factors such as the increase in supply of dentists (as @Dentalnerdz showed us), the increase in dental schools (also related to the previous point) the proliferation of midlevel providers, and more, we begin to get a not so rosy picture.

In the 70s, you could open up shop right out of dental school, and student debt could be cleared relatively quickly.

Times are changing. It's up to us to be aware of the field we're getting into and to make wise decisions for the future.

Dentistry will remain a great career path for those who plan ahead and minimize their debt. But it requires careful research.

 

[Cranjis McBasketball]

I agree that it'll never be a bad profession.

The issue is that in the 1970s, dental school costed $15,000 a year. After adjusting for inflation, that's about $70,000/yr in today's dollars.

But many private schools are charging $100,000+/yr. USC's first year is above $130K now. Just for 1 year. So the debt to income ratio is rising.

Now, that may not be a serious issue by itself, but when you consider various other factors such as the increase in supply of dentists (as @Dentalnerdz showed us), the increase in dental schools (also related to the previous point) the proliferation of midlevel providers, and more, we begin to get a not so rosy picture.

In the 70s, you could open up shop right out of dental school, and student debt could be cleared relatively quickly.

Times are changing. It's up to us to be aware of the field we're getting into and to make wise decisions for the future.

Dentistry will remain a great career path for those who plan ahead and minimize their debt. But it requires careful research.

I agree completely. And it'll probably just keep pumping out more graduates as less are tending to go to med school. What I really meant is there aren't many jobs that don't have a "bleak" looking future, especially in Health Care. No one knows what is going to be happening with health care.

 

[Dentalnerdz]

Here is another one.

 

[Advance]

Whose future would you say is more uncertain, Medicine or Dentistry?

Each field has their own set of problems. No one can tell the future. I say pick the one you like most and hope for the best.

 

[fancymylotus]

Yeah, what advance said.

And for gods sake, make smart investments and don't blow your money the second you start making it. I promise, buying the fanciest car and the fanciest piece of real estate and posting Instagram pictures of yourself in first class seats on every flight isn't that impressive, nor is it worth it.


Sent from my iPhone using SDN mobile app

 

[Cranjis McBasketball]

Whose future would you say is more uncertain, Medicine or Dentistry?

Wish I knew. I think medicine has it bad too. PA's and CRNA's have been pumping out graduates so they are also going to be saturated here really really soon. I don't think doctors will face saturation, as many students seem to choose alternative routes, but they have their own set of problems. As for me, I would choose dentistry over and over again. I think it has the brightest future, as long as you can keep your debts low.

 

[Apramana]

Once we begin to see lawsuits arise on the medical side from mid-level encroachment and overuse, I would think the situation for physicians will improve dramatically.

It appears that dentistry has managed to limit mid-level encroachment more effectively at this point, but encroachment by corporations into the dental world is beginning, and so we may rapidly see similar rates of dentists as employees as we do with physicians as employees, which will likely bring wages down.

One issue to consider is that it only takes four years to produce a general dentist, where it takes at least seven to produce a primary care physician, so there's a greater barrier on physician supply, which will likely reduce saturation and wage-depression issues when compared to dentistry.

---
Edit: Also, since most of medical reimbursement seems to be currently based on insurance company rates and/or Medicare and Medicaid reimbursement, it appears that physician salaries will remain relatively stable unless we see a major overhaul of the entire reimbursement system.

Dentistry, however, which is not yet dominated by insurance companies or government repayment models, will likely see a reduction in reimbursements if those systems ever become dominant.

I would think insurance company creep may be in dentistry's future, especially since programs like the ACA create a much more restrictive environment for insurance companies to operate in. Finally, if we ever transition to single-payer healthcare, I would think medical insurance companies will very rapidly view dentistry as a very viable target for their continued survival, and simply transition from being medical insurance companies to dental insurance companies.

In addition, medicine seems a bit more protected in terms of competition by other practitioners, as physician reimbursement rates are relatively set, as I mentioned above. However, in dentistry, costs seem to be less static, and thus competition by new practitioners can matter to a much greater degree.

This post seemed relevant:
"The [medical education] process is painfully expensive and inefficient. There is no reason that at least the 1st year of medical school could be online, and decrease med school to 3 years (or perhaps 2.5 years). Medical schools are ridiculously expensive because there is no check on their tuition levels -- they charge $60K per year and people pay it. Med Schools then justify those high tuition levels by saying that the money goes to other medical school missions -- research, etc. It's a natural outcome of limited supply (managed by the AAMC) and high demand (from high physician salaries).

The only part that I disagree with is that this probably has a minimal impact on the cost of care. An increased physician supply won't change the cost of care much, because most payment for services is fixed by the insurance company. Hence, if a new PCP opens next to someone who is established in an area, that doesn't tend to drop prices (unlike a new pizza place opening next to an established one). But I agree that the cost of care in this country is killing us. The question is whether we are willing to pay the price to fix it -- everyone makes less money in medicine, and not everyone gets all the medical care they want."
(from @aProgDirector : http://forums.studentdoctor.net/thr...st-in-nrmp-match.1188844/page-3#post-17550458 )

Dentistry seems to be less prestigious in society than medicine, however, so that might also be a buffer against competition or increased supply.

I can't think of any television dental dramas, but I can think of quite a few medical dramas over the years, and many films where medical doctors feature prominently, and feature prominently as positive figures in society. Dentists seem to fare a little worse in their portrayal in the media, which likely results in fewer applicants that are interested based on the potential for prestige.

 

[Cranjis McBasketball]

I'm a really simple guy, I just want a profession where I can do my job and not have to worry about paying the bills. I don't want to be miserable working so long and hard in medicine, because to be honest I will never define myself by my career or look at it as a calling, but at the same time I'm worried of being stuck in debt and struggling with the bills and regretting that I didn't work harder for security and peace of mind.

The biggest appeal of medicine to me is the 0% unemployment rate. If I did decide to do it that would be the main reason. Really hoping Dentistry is similar.

I don't think medicine is a simple profession. Its the 4 years of undergrad. Then 4 years of brutal med school. Then brutal residency. And then its finally your job. IF you want a simple job just to pay the bills and have decent hours and you don't mind not making a ton of money then honestly nursing is a great path. There is a huge shortage of RNs in a lot of areas. And because of that, their salaries are steadily increasing. And they have good hours.

Every job has their positives and negatives. The negatives with dentistry is that a lot of people view it as a perk and not a necessity. So when money is tight, the money people spend on dental is usually one of the first to go to something else. People will always see doctors when they need to. Just gotta outline what is most important to you and then you'll find your exact niche that you're seeking.

 

[Screwtape]

Would you mind elaborating on this? Where would a dentist dramatically benefit financially speaking as opposed to other areas? Obviously you're not going to be doing as well in NY or CA for the most part, but I'm looking for less obvious examples and situations. I think @smurfeyD and @DentalLonghorn2014 also chimed in to a degree on this topic in the thread.

Basically any area where there are fewer dentists compared to the overall population-- usually rural areas. So in general, smaller isolated towns not on the coasts.

 

[Ollivander]

Basically any area where there are fewer dentists compared to the overall population-- usually rural areas. So in general, smaller isolated towns not on the coasts.

Would that not also drive down the demand for aesthetic dentistry? Would you not say that's where the best returns are?


Sent from my iPhone using SDN mobile

 

[Cranjis McBasketball]

I agree that it'll never be a bad profession.

The issue is that in the 1970s, dental school costed $15,000 a year. After adjusting for inflation, that's about $70,000/yr in today's dollars.

But many private schools are charging $100,000+/yr. USC's first year is above $130K now. Just for 1 year. So the debt to income ratio is rising.

Now, that may not be a serious issue by itself, but when you consider various other factors such as the increase in supply of dentists (as @Dentalnerdz showed us), the increase in dental schools (also related to the previous point) the proliferation of midlevel providers, and more, we begin to get a not so rosy picture.

In the 70s, you could open up shop right out of dental school, and student debt could be cleared relatively quickly.

Times are changing. It's up to us to be aware of the field we're getting into and to make wise decisions for the future.

Dentistry will remain a great career path for those who plan ahead and minimize their debt. But it requires careful research.

I don't have an in state school either. How do you plan on minimizing your debts? Because, I agree, HPSP this year seemed near impossible to receive

 

[Incis0r]

I don't have an in state school either. How do you plan on minimizing your debts? Because, I agree, HPSP this year seemed near impossible to receive

HPSP is a good option.

 

[Screwtape]

Would that not also drive down the demand for aesthetic dentistry? Would you not say that's where the best returns are?


Sent from my iPhone using SDN mobile

Yes esthetics are not paramount in most smaller rural practices, at least comparatively to urban areas. But when you factor in the lower overhead due to cheaper rent, little to no marketing, lower staffing costs due to lower COL, no reason to take bad PPO or HMOs, etc., rural dentistry is generally more easily profitable. The best "returns" depends on a lot of things-- the lower your overhead, the higher your returns in simple terms. No doubt a flourishing practice in NYC that does high volumes of very nice and expensive esthetic work could have "high returns", its just more challenging to do that with the amount of competition. Returns and profitability can be very complex and are different for every practice, I'm speaking in broad strokes here.

 

[Ollivander]

Yes esthetics are not paramount in most smaller rural practices, at least comparatively to urban areas. But when you factor in the lower overhead due to cheaper rent, little to no marketing, lower staffing costs due to lower COL, no reason to take bad PPO or HMOs, etc., rural dentistry is generally more easily profitable. The best "returns" depends on a lot of things-- the lower your overhead, the higher your returns in simple terms. No doubt a flourishing practice in NYC that does high volumes of very nice and expensive esthetic work could have "high returns", its just more challenging to do that with the amount of competition. Returns and profitability can be very complex and are different for every practice, I'm speaking in broad strokes here.

This was the answer I was looking for. This was absolutely perfect. Thanks for the response!

 

[romoxx23]

Can't see the title, could you type the name for me please? Thanks

Of Course! "Success Profitability and Destiny BEGINS WITH YOU"