To specialize or not?

[whatisit350]

Hey all,

I just got accepted to dental school and will be starting school this fall. One thing I was told by a student was that we should know whether or not we wanted to specialize before we started school. He said we didn't have to know what speciality we would want to go into, but we should know if we wanted to specialize. I understand where he's coming from, since GPA is a huge factor, and it matters even from the first semester of school, as a factor as who gets to do what residency, if any at all.

So my question is, should I specialize or not? I've been thinking about the pros and cons of specializing in something like ortho, or perio vs. general dentistry. So far, what I can come up with is it seems like a lot of general dentists do best in rural settings, where specialists do well in the city. Also, it appears like the general dentists are doing most of the easy cases them selves, and referring out the hard cases to the specialists. Meaning that the specialists basically only handle hard cases (doesn't sound very fun for specialists).

Are there any other pros and cons of specializing vs general dentistry?

Thank you in advance!

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[321931]

Hey all,

I just got accepted to dental school and will be starting school this fall. One thing I was told by a student was that we should know whether or not we wanted to specialize before we started school. He said we didn't have to know what speciality we would want to go into, but we should know if we wanted to specialize. I understand where he's coming from, since GPA is a huge factor, and it matters even from the first semester of school, as a factor as who gets to do what residency, if any at all.

So my question is, should I specialize or not? I've been thinking about the pros and cons of specializing in something like ortho, or perio vs. general dentistry. So far, what I can come up with is it seems like a lot of general dentists do best in rural settings, where specialists do well in the city. Also, it appears like the general dentists are doing most of the easy cases them selves, and referring out the hard cases to the specialists. Meaning that the specialists basically only handle hard cases (doesn't sound very fun for specialists).

Are there any other pros and cons of specializing vs general dentistry?

Thank you in advance!

You should just keep your grades up so that later down the road 4 years from now you can do it if you wanted to. The person who you are today will be totally different in 4 years. Just keep the grades up in case you wanted to specialize...and just because you have high grades doesn't mean you HAVE to specialize. I know plenty of fine GP's that do fine without a "high" gpa.

 

[2TH MVR]

Keep your grades up in case you want to specialize. Then you will have options. Once in the dental school trenches .... you will know what areas of dentistry you like and want to pursue. I never had intentions to specialize until D2.

Cannot comment on the specialists better off in the cities. Rural vs cities both have their pros and cons. Deciding where to practice involves not just you, but your family. My wife is a city girl and I didn't have a choice in the matter. LOL.

Most important of all is to do what YOU want to pursue. This is will define you the rest of your life. As you may have read on here ... some specialties are not doing as well as others. You will have to decide if your passion for that particular specialty is worth the time, effort and $$$$$$ to pursue.

The other thing about specializing is that you will need to have excellent (I need your referrals) skills when speaking to general dentists. You need them more than they need you.

Good luck.

 

[ncide]

Insurance will always pay more to the specialist for the same procedure done by the generalist.

Do you want to work harder? Choose not to specialize.

 

[kingme23]

Insurance will always pay more to the specialist for the same procedure done by the generalist.

Do you want to work harder? Choose not to specialize.

But when the GP can do 2 or more easier cases of that procedure in the same time it takes the specialist to do that one long difficult case, that pay difference isn’t so significant 😉.

 

[kingme23]

Outside of maybe Prosth, specialists do harder procedures faster than GP’s do easy ones. They also get paid more. If your comment was true there wouldn’t be such a large gap in income between most specialists and GP’s. No offense to GP’s, but find me a GP that can take out 4 wisdoms in under 30 min, or a max molar Endo in less than an hour. There will be some, but not many.

I honestly think with the cost of attending dental school being so high, specializing is the best way to ensure future financial stability. Just my opinion. You obviously have to love what you do, or you’ll be miserable.

Yes given a difficult procedure, a specialist will usually be faster than a GP. My point was, a GP could do several “easier” procedures in the time it takes the specialist to do one difficult procedure, if the GP is good in that area. For example, an OS would get reimbursed more for taking out a very deep impacted wizzie, but a GP good at surgery could extract at least 3 “easy” teeth in the same time it takes that surgeon to take out the wizzie. How much pay difference is there really between those 2 scenarios? A GP good at endo could probably do 2 anterior endos in the time it takes the endodontist to finish 1 difficult molar with 4 or more canals with curvature and calcification. Also ask any endodontist and a lot of them will say it takes them LONGER to do endo now that they’re a specialist because they now realize how complex cases can be.

The pay gap you speak of exists in my mind because of a few reasons that have nothing to do with reimbursement:
-higher overhead with GP office
-GPs have to do lower producing procedures like fillings which prevent them from doing high producing procedures all day
-doing lots of “easy” cases requires lots of work and could cause lots of neck/back strain

Btw, not to brag but even in my 3rd year of school there were several times I took out 4 wisdom teeth in less than 30 minutes. They were not impacted nor fractured...not that unreasonable for someone who enjoys and is good at surgery.

 

[Munks]

As you can see OP, there are a large number of factors to consider whether you should specialize or not, and everyone will have strong differing opinions of one or the other. The truth is both ways work - otherwise the other wouldn't exist. Not to mention how much you would even like a particular field of specialty. I'd say just keep your grades up to allow you the option of specializing in the future. It will make it far easier to specialize from a good spot, rather than trying to claw your way back from the low ground.

 

[BluntForceTrauma]

Hey all,

I just got accepted to dental school and will be starting school this fall. One thing I was told by a student was that we should know whether or not we wanted to specialize before we started school. He said we didn't have to know what speciality we would want to go into, but we should know if we wanted to specialize. I understand where he's coming from, since GPA is a huge factor, and it matters even from the first semester of school, as a factor as who gets to do what residency, if any at all.

So my question is, should I specialize or not? I've been thinking about the pros and cons of specializing in something like ortho, or perio vs. general dentistry. So far, what I can come up with is it seems like a lot of general dentists do best in rural settings, where specialists do well in the city. Also, it appears like the general dentists are doing most of the easy cases them selves, and referring out the hard cases to the specialists. Meaning that the specialists basically only handle hard cases (doesn't sound very fun for specialists).

Are there any other pros and cons of specializing vs general dentistry?

Thank you in advance!

To paraphrase @Advance

D1 Student
First Month:
"Oh yeah, I'm prolly gonna specialize. IDK, definitely thinking about OMFS, but maybe Ortho. I mean, I wouldn't consider myself a gunner, but yeah."
Second Month:
"You know, Prosth looks pretty good right now. I think that is definitely for me."
Third Month:
"Specialize, me? No, no, I've had my sights set on GP since day one."
End of 1st Semester, right before finals:
"Passing sounds real good about now."

That said (somewhat in jest, but also serious) the above advice is 100% correct. Work hard, keep your grades up. It will only help you in all facets of your dental career (though you may get less sleep than your comrades), even if you don't end up going the specialty route. Don't kill yourself for anything though. I'd like to keep the door open, but with a wife and daughter, and hopefully more kids on the way, I won't sacrifice the family for the career (grades).

 

[Advance]

To paraphrase @Advance

D1 Student
First Month:
"Oh yeah, I'm prolly gonna specialize. IDK, definitely thinking about OMFS, but maybe Ortho. I mean, I wouldn't consider myself a gunner, but yeah."
Second Month:
"You know, Prosth looks pretty good right now. I think that is definitely for me."
Third Month:
"Specialize, me? No, no, I've had my sights set on GP since day one."
End of 1st Semester, right before finals:
"Passing sounds real good about now."

That said (somewhat in jest, but also serious) the above advice is 100% correct. Work hard, keep your grades up. It will only help you in all facets of your dental career (though you may get less sleep than your comrades), even if you don't end up going the specialty route. Don't kill yourself for anything though. I'd like to keep the door open, but with a wife and daughter, and hopefully more kids on the way, I won't sacrifice the family for the career (grades).

Lmao you know me so well .

 

[Big Time Hoosier]

I won't sacrifice the family for the career

If you've got a family in school, you absolutely need to make time for them. Try having a kid born during finals week (though my wife did most of the work there)! That'll stress you to the max.

Big Hoss

 

[321931]

Yes given a difficult procedure, a specialist will usually be faster than a GP. My point was, a GP could do several “easier” procedures in the time it takes the specialist to do one difficult procedure, if the GP is good in that area. For example, an OS would get reimbursed more for taking out a very deep impacted wizzie, but a GP good at surgery could extract at least 3 “easy” teeth in the same time it takes that surgeon to take out the wizzie. How much pay difference is there really between those 2 scenarios? A GP good at endo could probably do 2 anterior endos in the time it takes the endodontist to finish 1 difficult molar with 4 or more canals with curvature and calcification. Also ask any endodontist and a lot of them will say it takes them LONGER to do endo now that they’re a specialist because they now realize how complex cases can be.

The pay gap you speak of exists in my mind because of a few reasons that have nothing to do with reimbursement:
-higher overhead with GP office
-GPs have to do lower producing procedures like fillings which prevent them from doing high producing procedures all day
-doing lots of “easy” cases requires lots of work and could cause lots of neck/back strain

Btw, not to brag but even in my 3rd year of school there were several times I took out 4 wisdom teeth in less than 30 minutes. They were not impacted nor fractured...not that unreasonable for someone who enjoys and is good at surgery.

Specialist office tends to make alot more money because they add on alot of extras that patients tend to accept more freely compared to a GP office. For example, I do a surgical for 225. I get it out in 30 minutes. Put sutures in and done.

I KNOW for a fact that if I sent my patient to my OS they will bill for IV sedation, bone graft, membrane, collagen plug, whatever. The same surgical ends up at 1000$ with most of it out of pocket expense. Patients have no problem payinig this for an "ORAL SURGEON SPECIAL OFFICE...", its different for a GP. People feel as though they were referred to this higher specialty because their tooth is "so hard to take out" that it justifies the treatment plan. When they are presented with 1000 cost for a surgical at a GP office, they most likely will go shop around instead.

 

[321931]

The best and fastest route to financial freedom via dentistry is probably to own right after dental school. Why would you go into more educational debt when dschool debt is already so high, especially when you can do a cheap startup? If money is your end goal, then taking out a practice loan right after dschool may be a better choice than amassing more educational debt for specializing (obviously doesn't apply to OMFS and some peds/ortho) and forgoing at least two years in lost income.

Ownership is the best route, although most new grads are incompetent and need 1-2 years of corporate dental experience to be able to manage/be mature enough to own a high producing practice.

I would say start up is NOT the way to go unless Amazon decides to move in Podunkville middle of nowhere and you can run over there RIGHT NOW and setup shop immediately next to the residential campus. The great thing about startups is that yes you can have new equipment and a cool office for 300-500k but you have zero cash flow and you MAY struggle for a year...or two....or even 5 or 10 years. You want to live your prime barely breaking even or in the negative??? That sucks dude. Yes we all hear stories of start-up and making 1 mil in 1 year. That's not the reality. Theres alot more struggling start-ups that people sell to brokers as "turn key practices" Waste time for 2-5 years and make no income. What a waste of time and sad. Think about it, there are more dentists graduating, dentistry is becoming a corporate thing where patient's value 19.99 exam with free xrays over a quality clean/exam. Why would the market be productive for a start-up in such an environment?

Go with ownership, buy a good practice that can service your debt, make a good income, and don't be stupid and buy big expensive things.0 Treat your staff/patients well and you will be better off then a startup.

 

[kingme23]

Ownership is the best route, although most new grads are incompetent and need 1-2 years of corporate dental experience to be able to manage/be mature enough to own a high producing practice.

I would say start up is NOT the way to go unless Amazon decides to move in Podunkville middle of nowhere and you can run over there RIGHT NOW and setup shop immediately next to the residential campus. The great thing about startups is that yes you can have new equipment and a cool office for 300-500k but you have zero cash flow and you MAY struggle for a year...or two....or even 5 or 10 years. You want to live your prime barely breaking even or in the negative??? That sucks dude. Yes we all hear stories of start-up and making 1 mil in 1 year. That's not the reality. Theres alot more struggling start-ups that people sell to brokers as "turn key practices" Waste time for 2-5 years and make no income. What a waste of time and sad. Think about it, there are more dentists graduating, dentistry is becoming a corporate thing where patient's value 19.99 exam with free xrays over a quality clean/exam. Why would the market be productive for a start-up in such an environment?

Go with ownership, buy a good practice that can service your debt, make a good income, and don't be stupid and buy big expensive things.0 Treat your staff/patients well and you will be better off then a startup.

How do you feel about the approach some of the docs on here took with their startup, who were successful (coincidence?): cheap startup for ~150-200K with room to expand later instead of balling out and spending 700K, and initially working part time at the new practice while supplementing part time at another office or corp practice until the startup gets busy enough. Don't have to train a staff to learn new ways, aren't inheriting a practice full of recalls who have most of their treatment completed. From what I've seen, retiring docs usually want crazy dollars for their practices.

Either way, I have to think that in most places where people would do a startup, it would be much easier to succeed opening a general practice than a specialty practice.

 

[TanMan]

As a specialist, you'll get cases that are not worth the GP's time. You're also the end of the line, if they refer to you, I believe it looks bad if you end up having to refer to another specialist in the same field (unless it is some obscure subspecialty such as an OS that specializes in nerve repair). The era of dentists referring easy cases to the specialist are close to over. You'll also be doing procedures that carry more risk. I would say that it's better to do more low risk procedures at nearly the same fee as your specialist counterparts with more risk.

Another myth I see often, GP's cannot charge as much as specialists. While this may be true for insurance covered services, this depends on where your practice is located. Remember, objections to finances goes away pretty quickly when the patient is in pain. If you are getting bargain hunters in your office, you may not be marketing to the right demographic unless you aim to be a low-cost leader or you're not setting up the appropriate barriers to screen them out.

If an OS can take out teeth pretty quickly with training and experience, why can't a GP either. They are relatively quick with complex procedures, but we can be quick with simple procedures over time. Being a specialist doesn't make them suddenly great in all procedures, they all come with training and experience. Some people learn faster than others. Example would be 4 bi EXT's. 4 bi's on a teenager take 1-4 mins for all 4 unless there's some nasty curvature. If you were to receive 4 bi's an OS, I bet you something was wrong with the case to begin with (difficult patient, crazy dilacerations, ankylosis, etc...)

Edit: I'm in the other camp (pro startup). I think I've driven the point across many many threads. The main idea to think about is: what allows you to start producing with the least amount of capital as possible. Purchasing a practice requires significant capital and although you may have a more stable recall base, if the patients stick with you, the value of a recall patient whose treatment has been completed is a lot less than a new patient. Buying a practice is almost like buying a bond that you have to work for. I think this goes back to the key success of a startup... advertising. There's success in both startup and purchasing a practice. I think you're just buying more problems when it comes to buying a practice. Of course there's more uncertainty when it comes to a startup. You could easily crash and burn, but you could also crash and burn in a practice acquisition (although I'd see it more so slowly drowning in debt servicing). Working/saving 100-150k to start your own practice carries a lot less burden than borrowing 700k-1m+ to buy a practice. In one of the other posts, I think I went over the pitfalls of purchasing a practice.

 

[BluntForceTrauma]

View attachment 230180

If you've got a family in school, you absolutely need to make time for them. Try having a kid born during finals week (though my wife did most of the work there)! That'll stress you to the max.

Big Hoss

Oh for sure dude. I dedicate at least 1 full day, no school or anything else, each week. Then there are evenings when I come home before the little one goes to bed that I put away the phone and school work and just chill with them. Gotta keep it alive and thriving!

And man, hopefully our family planning will avoid that (but how often does that actually work anyway?) but I can't imagine haha. Kudos to you, and your wife. We all know they the real MVP =)

 

[Svart Aske]

It's nice to know what you want to specialize in before entering dental school, but the truth is most people have no clue.